Dr. Catalona Featured at the AUA Conference
Dr. Catalona Argues that Biopsies are Still Necessary in Active Surveillance
Dr. Catalona participated in a plenary session at the conference entitled Crossfire: Controversies in Urology: Prostate Cancer Active Surveillance Can be Done with mpMRI and Biomarkers; Biopsies are No Longer Necessary. The debate centered on the question of whether patients with low-risk disease on active surveillance still need a biopsy every two years, or whether the use of non-invasive biomarker tests or a multiparametric MRI can determine if they can skip these standard surveillance biopsies.
The panel included a debate with Mark Emberton, M.D., Eric A. Klein, M.D. arguing in favor of biomarkers to reduce biopsies. William Catalona, M.D., and Samir Taneja, M.D. argued that biopsies are still necessary. The panel was moderated by Christopher Evans, M.D.
Current active surveillance protocols vary, but generally include routine PSA testing and surveillance biopsies. There is not a clear consensus on the use of multiparametric MRI and genomic biomarkers in the setting of active surveillance.
In his portion of the presentation Dr. Catalona argued that biomarkers are not sufficient substitutes for surveillance biopsies at this time, as surveillance biopsies are more accurate than biomarkers. He noted that an ideal substitute for surveillance biopsies would have a very high positive and negative predictive value, add independent predictive information about risk, work for all different subtypes of prostate cancer, detect alterations in tumor status over time, and yield reproductive results across institutions and populations. It would also be convenient and cost-effective.
Most of the predictive biomarkers were developed in men with high-risk disease. Although some have been shown to add prognostic information in low-risk cohorts, they were largely in company- driven, non-randomized studies. Therefore, they were subject to potential biases. Genes and pathways that are correlated with high-risk disease may be different for men with lower-risk disease. In addition, different biomarkers may operate differently in men with different racial and ethnic backgrounds.
Dr. Catalona pointed out that biopsies work for all subtypes of prostate cancer—low- and high-risk—and across all populations. Biopsies also provide predictive information regarding the aggressiveness of the disease, which is better than MRI and all biomarkers. Furthermore, Dr. Catalona pointed out statistics showing that men are less likely to comply with active surveillance biopsies over time, which can lead to a higher risk of treatment failure and developing metastatic disease.
Detailed coverage of the debate session appeared in UroToday. Visit the Media Coverage page on URF website at for a link to the article.
Prostate Cancer Update Course
Dr. Catalona and his colleagues also led their annual AUA Prostate Cancer Update course, which reviews the prostate cancer scientific literature for the past year, selecting articles and topics that have immediate or possible near- term relevance for clinical practice. Many studies covered in QUEST were included in the Prostate Cancer Update course.
Ramon Guiteras Award Recipient
As reported in the Spring 2020 QUEST, Dr. Catalona was awarded this year’s Ramon Guiteras Award for outstanding leadership in demonstrating the value of PSA testing and surgical management of prostate cancer. This is the association’s most prominent award, which is presented annually to an individual who is deemed to have made outstanding contributions to the art and science of urology.