Dr Jonathan Epstein

APCC 2017 – Dr Jonathan Epstein

Dr Jonathan Epstein discusses the critical role of pathological grading in determining men suitable active surveillance.

Talking Urology podcast transcript

APCC 2017 Interviews - Jonathan Epstien

Jonathan Epstien: Hi, this is Jonathan Epstien from Johns Hopkins in Baltimore. So, I’ve given several talks. One was on the critical role of pathology in active surveillance and in that talk I discussed how pathology is critical for the definition for who is a good candidate for active surveillance as well as for those for the definition of progression or grade B classification active surveillance, whereas many clinical factors such as serum PSA levels we have found not to be useful to whose strong with classification. The critical aspect is grade. The talk I’m going to be giving shortly is on unusual subtypes of prostate cancer such as prostate cancer with neuroendocrine differentiation, small cell carcinoma, carcinomas with mucinous differentiation which has now been shown to be not that aggressive of a carcinoma as well as some more unusual cancers like sarcomatoid carcinoma.

A/Prof Nathan Lawrentschuk: Thanks. Well, great Jonathan. What do you think of ASCP now in the MRI era?

Jonathan: Yes, I think the whole thing with ASCP is with a typical brand suspicious for cancer is, there is an increased risk of carcinoma about 40% on repeat biopsy. Most of these are indolent cancers that one could argue maybe you don’t need to find and you could question whether you need to do a repeat biopsy. But about 20% of the cancers following an ASCP are still Gleason score 7 or grade group 2 or higher and so one is yes, you could use multiparametric MRI to try to identify if it’s higher grade, but still in my opinion even in negative multiparametric MRI it’s not 100%, it’s one of the factors to look into. Then combining that with molecular factors, again maybe not every man needs a repeat biopsy but I wouldn’t go so far to the other side saying none of the men need a repeat biopsy.

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