This issue of Grand Rounds in Urology provides a thorough review of available biomarkers and genomic tests for diagnosing clinically significant prostate cancer. It also discusses the challenges, implementation, and costs associated with these tests, and offers an algorithm incorporating the latest data for clinical use.

Keywords:
prostate carcinoma, biomarkers, PSA screening, antiandrogens, biopsy, aggressive prostate cancer

 

Faculty:

 

Medical Editor:

E. David Crawford, MD
Professor of Surgery, Urology, and Radiation Oncology Head, Urologic Oncology
E. David Crawford Endowed Chair in Urologic Oncology
University of Colorado, Denver
Aurora, Colorado

Faculty:

Paul Arangua
Research Assistant
University of Colorado, Denver
Aurora, CO

Salvatore P. Catarinicchia, MD
Surgery/Urology Resident
University of Colorado, Denver
Aurora, Colorado

John Hoenemeyer, MD
Urologic Oncology Research Fellow
University of Colorado, Denver
Aurora, CO

Robert E. Donohue, MD
Professor, Department of Surgery
University of Colorado, Denver
Aurora, CO

L. Michael Glode, MD
Professor, Division of Medical Oncology
Robert Rifkin Chair for Prostate Cancer Research
University of Colorado, Denver
Aurora, CO

Michael Maccini, MD
Urology Resident
University of Colorado, Denver
Aurora, CO

Priya N. Werahera, PhD
Research Assistant Professor
University of Colorado, Denver
Aurora, CO

Nick Westfall, MD
Urology Resident
University of Colorado, Denver
Aurora, CO

Cole Wiedel, MD
General Surgeon
Aurora, CO

 

References:

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64. Badani KK, Thompson DJ, Brown G, Holmes D, Kella N, Albala D, et al. Effect of a genomic classifier test on clinical practice decisions for patients with high-risk prostate cancer after surgery. BJU Int. 2015 Mar;115(3):419–29.

65. Klein EA, Haddad Z, Yousefi K, Lam LLC, Wang Q, Choeurng V, et al. Decipher Genomic Classifier Measured on Prostate Biopsy Predicts Metastasis Risk. Urology. 2016 Apr;90:148–52.

66. Simon R. Development and validation of therapeutically relevant multi-gene biomarker classifiers. J Natl Cancer Inst. 2005 Jun 15;97(12):866–7.

67. Antonarakis ES, Lu C, Wang H, Luber B, Nakazawa M, Roeser JC, et al. AR-V7 and Resistance to Enzalutamide and Abiraterone in Prostate Cancer. N Engl J Med. 2014 Sep 11;371(11):1028–38.

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69. Sarwar M, Semenas J, Miftakhova R, Simoulis A, Robinson B, Wingren AG, et al. Targeted suppression of AR-V7 using PIP5K1α inhibitor overcomes enzalutamide resistance in prostate cancer cells. Oncotarget. 2016 Aug 31;

70. Hearn JWD, AbuAli G, Reichard CA, Reddy CA, Magi-Galluzzi C, Chang K-H, et al. HSD3B1 and resistance to androgen-deprivation therapy in prostate cancer: a retrospective, multicohort study. Lancet Oncol [Internet]. 2016 Aug [cited 2016 Sep 8]; Available from: http://linkinghub.elsevier. com/retrieve/pii/S1470204516302273 grandroundsinurology.com

71. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67:7-30.

72. Sakr WA, Grignon DJ, Crissman JD, Heilbrun LK, Cassin BJ, Pontes JJ, et al. High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma between the ages of 20-69: an autopsy study of 249 cases. In Vivo 1994;8:439-43.

73. Lubeck DP, Grossfeld GD, Carroll PR. A review of measurement of patient preferences for treatment outcomes after prostate cancer. Urology 2002;60:72-7.

74. Meng MV, Elkin EP, Harlan SR, Mehta SS, Lubeck DP, Carroll PR. Predictors of treatment after initial surveillance in men with prostate cancer: results from CaPSURE. J Urol 2003;170:2279-83.

75. Crawford ED, Rosenberg MT, Partin AW, Cooperberg MR, Maccini M, Loeb S, et al. An Approach Using PSA Levels of 1.5 ng/mL as the Cutoff for Prostate Cancer Screening in Primary Care. Urology 2016;96:116-20.

76. Crawford ED, Moul JW, Rove KO, Pettaway CA, Lamerato LE, Hughes A. Prostate- specific antigen 1.5-4.0 ng/mL: a diagnostic challenge and danger zone. BJU Int 2011;108:1743-9.

77. Van NL, Hendriks RJ, Dijkstra S, Trooskens G, Cornel EB, Jannink SA, et al. Detection of High-grade Prostate Cancer Using a Urinary Molecular Biomarker-Based Risk Score. Eur Urol 2016;70:740-8.

78. Crawford ED, KO Rove, AB Barqawi, PD Maroni, et al., Clinical-pathologic correlation between transperineal mapping biopsies of the prostate and three-dimensional reconstruction of prostatectomy specimens. Prostate, 2013 May;73(7):778-87. doi: 10.1002/pros.22622. Epub 2012 Nov 20.

ABOUT THE AUTHOR

Researcher-physician E. David Crawford, MD, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.

He is currently a Professor of Urology at the University of California, San Diego, and emeritus distinguished endowed Professor of Surgery, Urology, and Radiation Oncology, and Head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles.

Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians.

In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC.

Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world.

Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf.

Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal.

He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.