The Role of Liquid Biomarker for Early Detection of Prostate Cancer - Episode 7
Expert urologists remark on unmet needs in prostate cancer by emphasizing the importance of reaching under-served communities, addressing patient discomfort, increasing education about liquid biopsy testing, and standardizing prostate size assessment.
David Albala, MD: do you see any unmet needs in early detection for prostate cancer? We have what we have now, do you think we can be better and what do you see in your crystal ball as you look forward? Your contributions in this area have been significant. You are a prolific writer, you've seen the changes much like I have, we saw the PLACO and the European studies for screening, we saw the task force recommendations. There has been a lot of changes that have happened over the years. First is, what do you see the unmet needs and what are your predictions for the future?
Judd W. Moul, MD: Just unmet needs. I can speak locally, I'm not sure if this would apply to everyone, but we still have unmet needs in our underserved population. We have a lot of underserved patients who are at high risk for prostate cancer and sadly, we still see those patients presenting too late. I do not have all the answers for that but that is clearly an unmet need. We have an unmet need in having patients be more compliant to following through on some of these tests. We have an unmet need in assessing the rectal exam. I know that sounds weird, but I wish there were a simple, very easy way, almost like a bladder scanner where one could measure prostate size a little more accurately but make it so easy where even it could be done in a primary care office. And I think that even in urology offices, if you could quickly get a prostate size estimate you could contextualize the PSA more effectively. PSA [prostate cancer antigen] density is a great task. We as urologists do these ultrasounds and do a pretty good job – we are not perfect; PSA density is powerful but it is not practical. What we talked about earlier, the prostate health index, the secondary blood test or the urine test, a lot easier to deploy than other things, but PSA density is useful if you can get it. Finally, I would say that we as a urologic community and our physician extenders, just to get more education in having a better understanding of how to use these secondary tests. How to decide when to use a pHi or 4K, how to use the urine test, and then when to apply MRI. We have tried to put algorithms in place at Duke and they work to some extent but there's still a lot of individual variation.
David Albala, MD: I agree. If we could standardize how to assess the size of the prostate. I remember the days when Merck would give us the little models of the prostate, there was 30 grams, 40 grams, 50 grams, and I remember trying to feel those. There was a disconnect with what you felt on the rectal exam and in the models but that was the best that we had back 20, 30 years ago. We are better, I think. We have become more sophisticated, we have used these tools, put them together. That is the beauty of what we deal with practice, that we are assimilating different tasks to try to decide. Because biopsy is a big commitment and there are complications, thank God they are relatively minor, but they do exist for patients and if we can be better clinicians, make diagnosis with a much more comfort level, I think that is what our goal is. Well, listen, this has been terrific. Judd, thank you. It is always great to work with you and I enjoyed my years with you. I just want to thank our viewing audience. We hope that you found these Uroview videos discussion today to be rich and informative. I look forward to working with you again and thank you for listening.
Judd W. Moul, MD: Thanks, David. It was a sincere pleasure. Really enjoyed it.
Transcript edited for clarity.