Who Needs a Prostate Biopsy?

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Screening and Prevention of Prostate Cancer 2021 (Part 2): Who Needs a Biopsy? – Summary:

In part 2 of a 3-part series, Sigrid V. Carlsson, MD, Ph.D., MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, goes over her 5 Golden Rules for prostate cancer testing, which are intended to minimize overdiagnosis and overtreatment while also making sure that significant disease is not missed. Rule 1 is to get consent and engage in shared decision-making with patients. Dr. Carlsson notes that this can sometimes be difficult since the numerous decision aids available are often difficult to use and understand. The second rule is not to screen men who will not benefit, for instance, older men with multiple comorbidities and short life expectancies. Dr. Carlsson does observe, however, that instituting an age cutoff does not necessarily make sense, and that physiologic assessment of life expectancy may be a more useful metric. In rule 3, Dr. Carlsson advises clinicians not to biopsy patients without a compelling reason, since prostate biopsies may lead to infectious complications and hospitalization. She then lays out the options for risk stratification, such as risk calculators, biomarker tests, and MRI. Rule 4 recommends against treating low-risk disease since, as Dr. Carlsson explains, active surveillance is a safe strategy over longer follow-up for appropriately selected patients with Grade Group 1 prostate cancer when following a well-defined monitoring plan. Finally, rule 5 exhorts clinicians to send patients who require treatment to a high-volume provider. This is key, Dr. Carlsson argues since the evidence shows that there is a large degree of heterogeneity among surgeons regarding functional and oncological outcomes after prostatectomy, and it takes approximately 250 surgeries for a surgeon to really master the procedure.

 

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ED - Evidence Based Causes and Treatments

Arthur L. Burnett II, MD, MBA, FACS Johns Hopkins University School of Medicine Baltimore, Maryland Arthur L. Burnett II, MD, MBA, FACS, is a Professor in the Department of Urology and Director of the Basic Science Laboratory in Neuro-Urology at Johns Hopkins University School of Medicine. His...

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Dr. Arthur Burnett, MD - Baltimore, MD - Urology - Book an Appointment

Find information about and book an appointment with Dr. Arthur Burnett, MD in Baltimore, MD, Lutherville, MD, Washington, DC. Specialties: Urology.

urology.jhu.edu

Arthur L. Burnett, II, MD is Professor, Department of Urology, at Johns Hopkins University School of Medicine, where he is also Director of the Basic Science Laboratory in Neuro-urology. Currently, Dr. Burnett holds professional appointments at the Johns Hopkins Hospital including Director of the Male Consultation Clinic and clinician-scientist at the James Buchanan Brady Urological Institute. Dr. Burnett received his undergraduate degree in biology from Princeton University and subsequently his medical degree at Johns Hopkins University School of Medicine. He then completed his internship and residency in surgery, and subsequently residency and fellowship in urology at the Johns Hopkins Hospital. Upon completion of his urology residency, he also received an American Foundation of Urologic Disease New Investigator Award to continue research work into the regulatory mechanisms of penile erection. He has maintained an active laboratory in neuro-urology since that time.

*Dr. Burnett is an established expert in the areas of prostate cancer; lower genitourinary tract malignancies (penile, scrotal, and urethral cancers); lower genitourinary tract reconstruction (pelvic trauma and urethral stricture disease); erectile dysfunction and penile abnormalities (including Peyronie's disease); and female urology (including urinary incontinence, urethral abnormalities, and prolapsed pelvic structures). This expertise is built on academic studies regarding the surgical anatomy of the pelvis, advances in surgical techniques of genital and pelvic reconstructive surgery, and basic science research contributions in the fundamental aspects of pelvic organ function.

*His focus in the clinical practice of prostate cancer is reflected by his performance of over 2,000 radical prostatectomy surgeries, his application of a single, minimally invasive 3-inch incision just above the pubic bone which facilitates rapid recovery and cosmesis, his application of the "nerve-sparing" technique as described by Walsh, and his development of management approaches to improve postoperative functional outcomes following radical prostatectomy (see Erection Rehabilitation after Radical Prostatectomy).

*Dr. Burnett is recognized for being a world-authority in the science and medicine of male erectile dysfunction. He contributed original discoveries of the nitric oxide biochemical mechanisms in erectile tissue, that paved the way for the clinical development of oral medications to treat erectile dysfunction such as Viagra. He has also pioneered work to develop therapies to protect penile nerve function required for improved erectile function recovery after radical prostatectomy.

A frequent contributor to the medical press, Dr. Burnett has written more than 150 original peer-reviewed articles, along with numerous additional articles, editorials, and book chapters, relating to his biomedical research and clinical activities. His work has appeared in many prominent journals such as Science, Nature Medicine, Proceedings of the National Academy of Sciences, Journal of Urology, Urology, and Journal of Andrology. A Fellow of the American College of Surgeons, Dr. Burnett is also a member of the American Urological Association, Sexual Medicine Society of North America, International Society for Sexual Medicine, Society of Genitourinary Reconstructive Surgeons, Society for Urodynamics and Female Urology, and the Society of Black Academic Surgeons. He has sat on various advisory committees including the Urology Study Section, National Institutes of Health Center for Scientific Review, an FDA Advisory Committee for Reproductive Health Drugs.

 

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*Dr. Burnett is an established expert in the areas of prostate cancer; lower genitourinary tract malignancies (penile, scrotal, and urethral cancers); lower genitourinary tract reconstruction (pelvic trauma and urethral stricture disease); erectile dysfunction and penile abnormalities (including Peyronie's disease); and female urology (including urinary incontinence, urethral abnormalities, and prolapsed pelvic structures)

*His focus in the clinical practice of prostate cancer is reflected by his performance of over 2,000 radical prostatectomy surgeries, his application of a single, minimally invasive 3-inch incision just above the pubic bone which facilitates rapid recovery and cosmesis, his application of the "nerve-sparing" technique as described by Walsh, and his development of management approaches to improve postoperative functional outcomes following radical prostatectomy (see Erection Rehabilitation after Radical Prostatectomy)

 

[Nelson Vergel]

Incorporating MRI for Early Prostate Cancer Detection

Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection – Summary: In the final part of a 3-part series, Sigrid V. Carlsson, MD, Ph.D., MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, considers the current role of MRI...

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[Nelson Vergel]

Excellent article: Prostate Cancer and the Waiting Game

Prostate Cancer and the Waiting Game Active surveillance isn't just about avoiding surgery -- it's also buying time

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[Nelson Vergel]

No Laughing Matter: Nitrous Oxide for Transrectal Prostate Biopsy

No effect on anxiety but significantly less patient-rated pain

www.medpagetoday.com