In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Ali Kasraeian, a private practice urologic oncologist in Jacksonville, about different techniques and research on prostate cancer screenings.

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SHOW NOTES

First, Dr. Kasraeian explains his interest in prostate cancer care. His father was a urologic oncologist who started a private practice, which he subsequently joined after completing his surgical training. He currently serves as a member of the Florida Prostate Cancer Advisory Council (FPCAC), a governor-elected board that raises public awareness for prostate cancer and brings practitioners and patient advocates together to advocate for this illness.

Next, the doctors discuss the optimal time to screen for prostate cancer. Dr. Kasraeian notes that the national guidelines can be confusing for primary care providers and patients because they are constantly changing. Additionally, different organizations have different guidelines. In his practice, he recommends obtaining PSA levels at 45 years of age if the patient has not had any risk factors or family history of prostate cancer. Dr. Kasraeian notes that he looks at PSA velocity instead of single elevated PSA value to make decisions about subsequent steps.

Then, he employs other screening methods, such as MRI scans and urine based biomarkers, if this is the case. He notes that biomarkers are useful because they can predict the risk of aggressive prostate cancer developing. Then, he will move onto obtaining a prostate biopsy if needed. The order of screening method will depend on the patient and their preferences. He emphasizes the importance of educating patients on the reasoning behind each screening test to allow them to become advocates of their own preventative cancer care.

He then speaks about his personal experience spending a year in Paris and learning how to incorporate MRI as a screening test in his own private practice. He ends the episode by discussing the future directions of prostate cancer screenings and care by making comparisons between the trajectory of prostate cancer and that of breast cancer, and commenting on the use of biopsy alongside the increasing capabilities of MRI scans.