Guilherme Godoy, MD, MPH, presented “Prostate Cancer Early Diagnosis Screening” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.
How to cite: Godoy, Guilherme. “Prostate Cancer Early Diagnosis Screening” September 14, 2018. Accessed [date today]. https://dev.grandroundsinurology.com/prostate-cancer-early-diagnosis-screening/
Prostate Cancer Early Diagnosis Screening – Summary:
Guilherme Godoy, MD, MPH, details the controversies surrounding the evolving United States Preventive Services Task Force (USPSTF) recommendations on PSA screening. He then emphasizes the need for individualizing risk assessment in clinical decisions-making for prostate cancer.
Abstract:
Particularly in the United States, there has been much controversy surrounding prostate cancer screening. Exacerbating this controversy is the binary analysis of PSA tests, with either a positive or negative result. While the standard cutoff point for these results is 4ng/mL, new proposals argue for a 2.5ng/mL cutoff point. This binary approach leads to unnecessary biopsies, overdiagnosis, and overtreatment that subjects patients to needless side effects.
As a result of these controversies, the USPSTF released a statement in 2008 assigning a grade “D” recommendation to PSA screening. The USPSTF then released an update to this in 20112. These statements had a basis in data from the ERSPC and the PLCO. However, there are many valid criticisms concerning both the trials’ designs and the USPSTF recommendations.
Urologists overall opposed the recommendations, as PSA can be valuable tool for detecting prostate cancer. A multitude of urologic societies responded to the USPSTF recommendations, arguing not to discard PSA altogether. Screening in the PSA-based era lead to fundamental changes in the natural history of prostate cancer. The advent of PSA screening marked a deflection in the projected curve of prostate cancer deaths, as well as mortality rates, from the early 1990s to 2015. Fortunately, the USPSTF revised their PSA screening recommendation to a “C” grade in 2018.
Because overdiagnosis and overtreatment are significant issues, clinicians must be judicial when analyzing PSA. It is important to individualize risks and personalize assessment through approaches such as PSA derivatives and utilizing risk calculators. Urologists currently have access to multiparametric MRI, MRI/ultrasound fusion, new molecular tests, and new PET agents to aid risk-stratification. Integrating these methods into clinical decision-making can ultimately mitigate unnecessary biopsies, overtreatment, and undertreatment without discarding PSA testing.
About Innovations in Urologic Practice
Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Godoy presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.
ABOUT THE AUTHOR
Dr. Godoy is an Assistant Professor of Urology and Urology Oncology at Baylor College of Medicine, Houston, Texas. He received his MD from Fundacao Universitaria do ABC in Sao Paulo, Brazil, and has received numerous fellowships at several institutions, including Memorial Sloan Kettering Cancer Center in New York City, Irmandade da Santa Casa de Misericordia de Sao Paulo Medical School in Sao Paulo, Brazil, Vancouver General Hospital in Vancouver, British Columbia, New York University School of Medicine in New York City, and Baylor College of Medicine. Dr. Godoy is skilled at managing patients with bladder cancer, kidney cancer, prostate cancer, and testis cancer. He also specializes in bladder issues, erectile dysfunction, kidney stones, and prostatitis. Dr. Godoy is a respected writer, researcher, and presenter as well, and has published numerous articles and papers. He has won a Best Published Clinical Research Paper Award from European Urology and has been recognized on several occasions as a Best Poster of the Section at American Urological Association Annual Meetings and European Association of Urology Annual Congresses. Dr. Godoy is also heavily involved in the medical community, both nationally and internationally. He is a member or candidate member of nine medical societies, including the Pan American Society of Anatomy, the Brazilian Society of Anatomy, the American Association of Cancer Research, and the Southwest Oncology Group.
