madman
Super Moderator
This expert panel discussion at the Southwest Prostate Cancer Symposium explores how prostate cancer screening and diagnostic decisions are made in real clinical practice. The conversation begins by discussing historical prostate-specific antigen (PSA) thresholds and why PSA alone is insufficient to guide care.
The panel focuses extensively on magnetic resonance imaging (MRI), including how often lesions are detected even with careful referral selection, how prostate imaging reporting and data system (PI-RADS) scores are interpreted, and how biparametric and multiparametric MRI fit into practical workflows. They explain how MRI integrates with biopsy planning and what happens when imaging and biopsy results do not align.
Pathology grading variability is examined, acknowledging disagreement even among experts. The discussion considers whether broader risk grouping may sometimes be more meaningful than strict grading precision and reviews thoughts on artificial intelligence in this setting.
Active surveillance is addressed in depth, including why many patients eventually transition to treatment, with biological, psychological, and communication factors all discussed. Audience participation expands the discussion to include screening in older patients, MRI-negative scenarios, racial and access disparities, and workflow constraints.
The group emphasizes individualized assessment, realistic expectations, multidisciplinary collaboration, and recognition that prostate cancer risk assessment remains complex and continually evolving.
