052IC - AUA Guidelines on Early Detection of Prostate Cancer: Maximizing Benefits, Minimizing Harm

Course Description: Prostate cancer detection remains one of the most common and most controversial aspects of urologic practice. In addition to the complexities around screening and use of PSA, the role of other biomarkers, biopsy techniques such as transrectal versus transperineal biopsy, and MRI for targeted biopsy are evolving rapidly. This course is intended for urologists, fellows, residents, advanced practice providers and trainees interested in using the most evidence-based methods for optimizing detection of clinically important prostate cancers, while maximizing patient experience and minimizing complications. The course faculty includes members of the Early Detection of Prostate Cancer: AUA/SUO Guideline (2023) panel and they will emphasize the new guidelines. Attendees will explore the continuing controversy of screening for prostate cancer, use of PSA, PSA adjuncts and isoforms, and other blood, urine and tissue-based biomarkers for prostate cancer detection. This will lead into a discussion of prostate biopsy, including concepts crucial to reducing morbidity of prostate biopsy and improving patient experience. This course reviews available data regarding biopsy indications and techniques, including a strong emphasis on trans-perineal prostate biopsy. Additionally, this course fully explores the imperative of having a purposeful approach to biopsy aimed at diagnosing clinically significant disease while minimizing detection of clinically insignificant cancer. We also present the most current information regarding the use of image guided biopsy techniques, such as MRI-ultrasound fusion guided biopsy. Finally, we will look toward the future of prostate cancer diagnosis, including risk-stratified testing, combination of tests, sequencing of imaging and biomarkers and ongoing initiatives worldwide. Overall, the course provides an evidence-based and practical overview of methods to detect and diagnose clinically significant prostate cancer.

Learning Objective 1: Apply the Early Detection of Prostate Cancer: AUA/SUO Guideline (2023), and understand the rationale, evidence, level of evidence, strength of recommendation and applications associated with each statement.

Learning Objective 2: Maximize the benefits and minimize the harms of prostate cancer detection by carefully selecting patients and by using the necessary tools to detect clinically significant prostate cancer, while avoiding unnecessary biopsies and detection of clinically insignificant prostate cancers.

Learning Objective 3: Identify the evidence supporting the use of PSA for early detection of prostate cancer, and apply that evidence to different clinical scenarios, incorporating patient characteristics and preferences.

Learning Objective 4: Define the available blood-, urine- and tissue-based biomarkers used to enhance detection of higher-grade prostate cancer, the evidence supporting their use, and the clinical scenarios in which they are most valuable to be used.

Learning Objective 5: Use MRI and fusion biopsy to enhance the detection of clinically significant prostate cancer and implement safe biopsy practices with respect to approach, avoidance of infection, and attention to patient comfort; understand the rationale for transperineal prostate biopsy and its technique; be able to establish a transperineal biopsy practice.