Great Strides in PSA Detection and Risk Stratification

Detection and risk stratification of localized prostate cancer was a major topic at the European Society for Medical Oncology virtual meeting. In this video courtesy of VJHemOnc, Eugene Shenderov, MD, PhD, of Johns Hopkins Medicine in Baltimore, discusses access issues for prostate-specific antigen (PSA) testing and newer approaches guiding risk stratification and treatment.

Following is a transcript of his remarks:

I think that we’ve made great strides in the field — in terms of PSA detection, in terms of guidelines for who should get PSA tested. And then of course for trying to risk stratify, there is still a lot of ongoing work. So the overall conclusion is I think that we’ve made great strides.

A lot of work still remains to be done. One is, we definitely still have a serious issue worldwide, I think, with figuring out not only the fact that we have guidelines, but also how to make sure that individuals are able to access healthcare of course — access to healthcare. To be able to follow those guidelines they have to have a primary care doctor in the first place to access PSA testing, for example, at the right time in their lives.

And then on top of that for risk stratification as well, we still have a lot of ongoing work to be done about figuring out which types of tests are sort of the best. There’s a lot of ways that we’re currently working on it — in terms of genomic risk stratification, in terms of course imaging-based modalities that are even more sensitive to capturing localized disease and micrometastatic disease. And as we, for example, have been developing, as a field, PSMA [prostate-specific membrane antigen] targeted agents and PSMA targeted detection, we realized that, for example, with conventional CT or PET/CT imaging, we might be of course missing [disease] — there’s a limit of detection. And so if you, for example, diagnosed someone with localized aggressive disease, but you fail to, by whatever imaging modality, work them up for the fact that they have micrometastatic disease and really have metastatic disease on presentation rather than high-risk localized disease or just localized disease — that would be a difference in terms of potentially how we approach treatment.

And so there is of course the limits of our technology at the moment, and a lot of work that’s ongoing is really addressing those issues. So I think that there’s never been a better time in a sense, for both detection and risk stratification of prostate cancer. We’ve got a lot more information than we’ve ever had to give to our patients. But of course this is an ever-evolving and fast-changing area where great promises are really in the air.

Last Updated October 11, 2021