Dr. Claire de la Calle

It's been associated with progression on surveillance.

Usually the cutoff of 0.15 is used, but other cutoffs have been studied as well.

In grade group 2 patients specifically, studies have shown that

Those patients, if they have a high PSA density, they're more likely to have adverse pathology at radical prostatectomy.

So I definitely take into account PSA density when counseling patients.

Now, I don't necessarily use it as a complete exclusion criteria.

I'm sure we all have, you have as well in your clinic, a few patients with high PSA density.

But I will definitely wonder, is there more volume of tumor that's not really well sampled?

So do I need to repeat an early biopsy?

I will monitor them more closely.

Yes.

And our guidelines do say that we should tailor the monitoring to the patient.

And so intermediate risk patients, we know are higher risk than low risk patients.

So we definitely should do it.

Now, how we should do it, again, no consensus.

So there's a lot of different protocols out there.

I'm lucky to work at University of Washington where the Canary Pass study is ongoing.

So a lot of my patients are on the pass protocol.

My intermediate risk patients, I am following more regularly and more intensely regularly.

Definitely PSA testing every six months at least.