Brief Highlight from this years' AUA Congress

We’ve just returned from the annual international meeting of the American Urological Association (AUA), which was held in Orlando, Florida. Our two hour course regarding Urologic Pelvic Pain was well received and we were especially satisfied with our new unconventional format which (we hope!) was more engaging and therefore more educational.

There were many exciting presentations showcasing the latest research, which I wish to share with you. As PSA has been shown to be an ineffective screening tool (Potts, Journal of Urology, 2010 and others) and the past decade has brought to light the over diagnosis and overtreatment of prostate cancer, the AUA has modified its guidelines. Meanwhile, many investigators have been looking for a better way to screen men--that is, to differentiate the men with high grade/aggressive cancer from those with low grade/indolent disease. In doing so, we avoid all the adverse effects of screening: false positives, fear, angst, cost, infection, rectal bleeding, spermatic bleeding, etc. We also avoid unnecessary prostatectomies, which can cause urinary incontinence and sexual impotence. Similarly, we avoid overuse of radiation therapy, which can cause voiding, bowel and sexual dysfunction.

PCA3, a urine test, has been shown to be more sensitive and specific than serum PSA; however, it still lacks the ability to distinguish high grade from low grade cancers. Some researchers, however, have shown that it may be used in combination with other tests. These include the Prostate Health Index (phi), a blood test used to evaluate the probability of prostate cancer diagnosis. It outperformed commonly used prostate-specific antigen (PSA) and free/total prostate-specific antigen (%fPSA) tests in predicting the presence of clinically significant prostate cancer and in improving prostate cancer detection. The phi combines measurements of %fPSA (percent of protein-attached and protein-free PSA circulating in the bloodstream) and a subcategory of free PSA called pro-PSA, and is estimated to be 2.5 times more specific in detecting prostate cancer in patients than a PSA screening.

Another test developed at University of Michigan, has also been shown to better identify patients with Gleason 7 or higher prostate cancer, i.e., higher grade disease, which would warrant intervention.. The new urine test looks for the T2:ERG fusion (believed to cause prostate cancer) as well as another marker, PCA3. This is combined with serum PSA measure to produce a risk assessment for prostate cancer. The result is the Mi-Prostate Score, or MiPS, which ahs been shown to be significantly more accurate than PSA alone for predicting cancer as well as predicting aggressive prostate cancer that is likely to grow and spread quickly.

While I am very excited about these tests, I remain cautious and selective with regard to prostate biopsy, despite having performed this procedure for thousands of patients. I continue to practice shared decision making with my patients and base screening and diagnostic options on individual health status, family history and digital rectal exam of the prostate. I look forward to employing these new tests as data and reagents become available.

Stay tuned for our announcement regarding the opening of our new clinic as Dr. Christopher Payne and I begin our collaboration as Vista Urology and Pelvic Pain Partners. Our mission includes research and clinical care as a “concierge academic center.”