During the state-of-the-art lectures in the eURO Auditorium, Prof. David Crawford (US) emphasised the need for a redefinition of the PSA biomarker, while Prof. Keong Tatt Foo (SG) sought to define IPP and BPH, and present the evidence for use of IPP for diagnosis.
“The best decision markers for biopsy and re-biopsy of the prostate are those which help determine whichmen have a cancer that would benefit from treatment,” said Crawford. According to the USPSTF and other organisations, physicians should not order PSA screening unless they are also willing to engage with patients and help them make an informed choice.
For Crawford, PSA should be routine, but the process of informed decision should only be done when the results are abnormal, which happens in around 30% of cases, according to screening data on more than 150,000 men. He then put forth biomarkers such as the 4K score and the PCA3, which could help eliminate needles repeat biopsies, and further differentiate the treatment pathway.
Prof. Keong Tat Foo began his presentation with a brief historical overview, and Benign Prostate causing Bladder Outlet Obstruction (BOO). He further stressed the importance of Intravesical Prostatic Protrusion (IPP), as useful for diagnosing and predicting BPH. This is because “Clinical BPH can be diagnosed more precisely with ultrasound (IPP) and uroflowmetry in the clinic,” said Foo. On the correlation of IPP with prostate volume and BOO, he added that IPP is a better predictor of obstruction than prostate volume.
He proposed that clinical decision making in LUTS and BPH needs to consider management as a whole, rather than “being like the blind man describing an elephant,” by only looking at IPP or IPSS/QOL, or PVRU alone. IPP predicts obstruction and progression of prostate adenoma, and PVR and QUL provide the stage. Therefore, If all measures are used, treatment can be tailored to the patient’s needs, and it can be more balanced and cost effective.