Episode # 3 • 17 Jan 2025
From Numbers to Decisions: Clinical Utility of Biomarkers in Prostate Cancer Diagnosis
Every prostate cancer biomarker returns a number, but the real question is whether that number changes what you do next for the patient. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Amir Lebastchi, urologic oncologist at Keck Medicine of USC, to discuss how biomarkers are moving prostate cancer care from numbers to meaningful clinical decisions. They define what makes a biomarker clinically useful, organize the growing list of blood, urine, and tissue tests into pre-biopsy, post-negative-biopsy, and post-diagnosis settings, and talk through where these tests fit alongside MRI after an elevated PSA.
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Timestamps
00:00 - Introduction
02:59 - Clinical Utility and a Framework for Biomarkers
08:43 - Workup of an Elevated PSA
11:42 - Pre-Biopsy Blood and Urine Tests
13:29 - Equivocal MRI, Outside Imaging, and Community Practice
20:26 - Patient Factors and Practical Considerations
24:44 - Case: Elevated PSA and a Negative MRI
30:11 - Case: Biopsy Approach and Discordant Results
34:41 - Counseling on PSA Limitations and Overdiagnosis
37:05 - Biomarkers in Active Surveillance and Renaming Grade Group 1
40:56 - AI and the Future of Biomarkers
44:38 - Take-Home Points and Closing Remarks
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More about this episode
The discussion covers equivocal MRI findings, patient counseling, and the practical impact of age, family history, and race when interpreting PSA levels. Through real cases, Dr. Lebastchi explains when he repeats a PSA, how he performs a templated transperineal biopsy, and why a negative MRI plus a negative biomarker can give him the confidence to forgo a biopsy. They also touch on active surveillance, the debate over renaming grade group 1 prostate cancer, and how AI may help future tests guide treatment intensity rather than just risk category. Dr. Lebastchi closes with the clinician’s obligation to know all available tests and use those that truly inform management.
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