Liquid biopsies, ctDNA, and the diagnosis and management of cancers

The American Society of Clinical Oncology (ASCO) and the College of Pathologists (CAP) have just issued a joint review of available information on clinical use of “liquid biopsies” to assess circulating levels of tumor DNA (ctDNA). … READ MORE …

Is MRI/TRUS fusion-guided prostate biopsy cost-efficient for all patients?

Slowly but perhaps inexorably we seem to be seeing increasing scientific and clinical justification for the argument that all men thought to be at risk for a diagnosis of prostate cancer should be given an MRI scan prior to any form of prostate biopsy. … READ MORE …

What patients are willing to pay for an MRI-guided biopsy (maybe)

A recent report in Urology Practice makes what we see as a somewhat odd statement about what patients may be willing to pay for an MRI/TRUS fusion-guided biopsy as opposed to a TRUS-guided prostate biopsy. … READ MORE …

Commercially available liquid biopsy data may be misleading

A newly published research letter in JAMA Oncology is entitled “Patient-paired sample congruence between 2 commercial liquid biopsy tests”. The two tests are both said — by the companies that market them — to have high clinical sensitivity and specificity in the identification of specific genetic markers associated with high-risk forms of prostate cancer. … READ MORE …

The role of the phi test prior to decisions about prostate biopsies

Yesterday morning, a newly published paper was brought to my attention. It reports that use of the Prostate Health Index or phi test in a partially prospective study can and did change urologists’ opinions about whether selected patients really do or don’t need to have a prostate  biopsy. … READ MORE …

What do urologists think about using MRI in prostate cancer diagnosis and management today?

Staff at the Urologic Oncology Branch of the National Cancer Institute have just published the results of a survey evaluating current knowledge of (some) specialist urologists and urologic oncologists about the roles of MRI scanning in the diagnosis of prostate cancer and how they are integrating the use of MRI scanning and MR-guided biopsies into their clinical practice. … READ MORE …

“The best” type of biopsy using mpMRI guidance to target the lesions

There have been suggestions that guided biopsies on the basis of multiparametric MRI (mpMRI) data are most accurate when done using so-called “in-bore” or “in-gantry” biopsies as opposed to mpMRI/TRUS fusion-guided biopsies. … READ MORE …

Does Test X change what physicians actually do and say to their patients?

One of the key ways in which we can (and do) assess the “value” of new types of medical test is by the degree to which they actually change the ways physicians act on the data and make decisions and/or recommendations about patient management. … READ MORE …

Who really needs to be given a prostate biopsy?

A newly published article in Reviews in Urology argues that, on economic grounds alone, the majority of patients thought to be at risk for prostate cancer should have a 4KScore test prior to them being given a biopsy since this test can rule out the need for biopsies with a high degree of accuracy. … READ MORE …

The evolution of evaluation of risk for clinically significant prostate cancer

Whatever one may happen to think about the value of the PSA test, we all know that it is very bad at actually telling a doctor or a patient if that patient is at real risk for clinically significant prostate cancer. So, from that perspective … READ MORE …

PSA density vs. PSA level and the prediction of prostate cancer risk

A newly published study in the journal Urology (the “Gold Journal”) has suggested that — at least for patients with a PSA level between 4 and 10 ng/ml — PSA density may be better than PSA level in the determination of which of these patients need to go on to have a biopsy. … READ MORE …

MRI as a means of screening for prostate cancer? Probably not!

A report on the HealthDay web site related to a presentation about the role of MRI scanning in the diagnosis of localized prostate cancer seems to demonstrate a significant division of views about the value of standardized use of mpMRI in the diagnosis of prostate cancer. … READ MORE …

Serial mpMRIs instead of serial biopsies for men on active surveillance

The role of baseline and repeat multiparametric MRI (mpMRI) scanning as a substitute for repeat biopsies in the initial evaluation and ongoing management of men on active surveillance continues to evolve. … READ MORE …

Risk, prostate cancer, and being 70 to 80 years of age

So a relatively new article in Reviews in Urology caught your Sitemaster’s eye this morning — and worried him because it seemed to be communicating a conclusion of questionable accuracy, which we will explore below. And if we have misinterpreted the data provide in the paper, we are more than willing to be corrected. … READ MORE …

PROMIS study endorses mpMRI prior to prostate biopsy for many patients

The PROMIS study is a UK-based study designed to confirm earlier data suggesting that having a multiparametric MRI (mpMRI) scan could really help to decide which men needed a prostate biopsy because they really did or didn’t have prostate cancer. … READ MORE …