This week on BackTable Urology, Dr. David Albala, chief of urology at Crouse Hospital, and Dr. Jose Silva discuss the benefits and integration of biomarkers in prostate cancer diagnosis.

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SHOW NOTES

First, Dr. Albala explains the history of PSA testing, which was the first test to screen patients for prostate cancer. He explains that in the past, positive PSA testing (>4 ng/mL) and digital rectal exams (DRE) could lead urologists to the decision to biopsy the prostate. He notes the importance of taking into account clinical risk factors, like age, family history, race, genetic markers like BRCA1/2. PSA cutoffs should also follow age-specific considerations, and PSA is not a specific test for cancer as some patients with biopsy proven prostate cancer can have normal PSA levels. Current USPSTF guidelines recommend PSA screening at age 45 in patients with risk factors (African American, positive family history, etc.) and at age 55 in patients without risk factors, but this should be subject to shared decision making.

Then, the urologists discuss the use of urine and blood biomarkers to determine whether a biopsy is necessary, as bleeding and infection are possible complications. Dr. Albala’s prostate cancer workup involves the following: a PSA level first, a repeat PSA level if the first one was between 2-10 ng/mL in a patient older than 50, and then the ExoDx exosome test. If the exosome test returns with a value greater than 15.6, he will perform an MRI fusion prostate biopsy. If the exosome test is less than 15.6, he will repeat the test in 6 months. He notes that benefits of the urine exosome test include affordability and reduction in the need for DREs and biopsies in patients without cancer.

Finally, Dr. Albala discusses future possibilities of layering biomarker tests and encourages early screening for prostate cancer. He ends the episode by emphasizing prostate cancer treatment should be personalized because many cases of prostate cancer are indolent and may be overtreated.

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RESOURCES

ExoDx Prostate Test:

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