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Expert Point of View: J. Kellogg Parsons, MD, MHS, FACS


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“Population-based screening for prostate cancer reduces prostate cancer mortality,” noted J. Kellogg Parsons, MD, MHS, FACS, Professor of Urology, UC San Diego Health, who commented on the study. “Effective screening programs focus on the early detection of aggressive but curable tumors, minimize the diagnosis of indolent tumors, and employ tailored, evidence-based approaches to prevent overtreatment of clinically insignificant cancer.”1 Dr. Parsons is also Vice Chair of the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology panel on Prostate Cancer Early Detection.

J. Kellogg Parsons, MD, MHS, FACS

J. Kellogg Parsons, MD, MHS, FACS

“Use of robust biomarkers to predict the probability of biopsy-detectable cancer underpins effective screening. Serum prostate-specific antigen remains the most prevalent screening test but lacks specificity and can lead to unnecessary prostate biopsies,” he continued. “Newer biomarkers have improved specificity for predicting higher-grade cancers and typically report a probability for detecting Gleason Grade Group (GG) ≥ 2 (Gleason 3+4 = 7) disease. These biomarkers include the serum-based Prostate Health Index and 4Kscore tests as well as the urine-based SelectMDx and ExoDX tests.”

“The urine-based Sentinel PCa Test [PCC4 assay] predicts the probability of higher-grade prostate cancer and provides an additional stratification for predicting GG ≥ 3 (Gleason 4+3 = 7) disease.2 While a promising assay with robust operating characteristics for prostate cancer detection, it remains unclear how this test compares with other existing urine- and serum-based prostate cancer biomarkers or how to combine it with prostate magnetic resonance imaging, which is increasingly utilized in the early detection of prostate cancer.”

“It is also important to emphasize that none of these assays—including the PCC4 assay—can as yet replace prostate biopsy, which remains the established standard for diagnosing prostate cancer,” Dr. Parsons concluded. 

DISCLOSURE: Dr. Parsons reported a clinical research support/data safety monitoring board relationship with Insightec; and has served as a scientific advisory board member, consultant, or expert witness for Janssen Pharmaceuticals.

REFERENCES

1. Carroll PR, Parsons JK, Box G, et al: National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection, Version 2.2021. Available at https://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf. Accessed October 4, 2021.

2. Wang WLW, Sorokin I, Aleksic I, et al: Expression of small noncoding RNAs in urinary exosomes classifies prostate cancer into indolent and aggressive disease. J Urol 204:466-475, 2020.


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