Dr. Claire de la Calle

And then in terms of DRE, our guidelines do say that we should not do DRE more than every 12 months.

I do admit that I am doing DREs less and less regularly, especially since COVID.

We started seeing a lot of our active surveillance patients through telemedicine, which I think is great and actually helps with compliance and keeping in touch with the patient and not forgetting about the cancer.

And I think the MRI is a great replacement for DRE, but for sometimes specific reasons, I will do them, but I don't have like a specific frequency for when I do them.

Yeah.

I think it's important to not use only one clinical factor when making that decision, really looking at the entire picture.

And that's very much stated in our guidelines as well.

I look at everything.

I look at the PSA, the PSA kinetics, the progression PSA density.

Is there an increase in the amount of pattern 4?

Is there suddenly new presence of cribriform type pattern 4 or intraductal carcinoma, new presence of perineural invasion?

Definitely progression of tumor volume on biopsy or MRI, like I mentioned earlier.

And certainly a change in stage as well.

So suddenly concern for extra prosthetic extension, for example, on MRI.

All of those things will make me want to consider treatment much more seriously.

And then sometimes genomic classifiers will also help me in deciding on need for transition to treatment.

Yeah, great question.

So the type of pattern four is, we know, very important, especially large cribriform.

There are studies that have looked at the sensitivity and specificity of identifying cribriform or introductal on biopsy.

And unfortunately, the sensitivity is low.