The downside of active surveillance (AS) for prostate cancer is the follow- up needle biopsies. Nobody likes them: not the men who feel like pincushions, and not the surgeons who do the repeated biopsies, sometimes for years. But everyone has agreed – because there hasn’t been a better approach – that it would be far worse to miss the presence of more aggressive cancer that needs to be treated.

This may soon change, thanks to a combination of better imaging and a smarter blood test, as shown in a recent study led by H. Ballentine Carter M.D., with Brady resident Zeyad Schwen, M.D., and biostatistician Mufaddal Mamawala, M.B.B.S., M.P.H.

In 1995, when Carter, the Bernard L. Schwartz Distinguished Professor of Urologic Oncology, started one of the world’s longest prospective AS programs in prostate cancer here at the Brady, biopsy, physical exam and the PSA test were the most reliable means of monitoring cancer. But now we have other good tools, including multiparametric magnetic resonance imaging (mpMRI) and the Prostate Health Index, a blood test that combines three forms of PSA (total PSA, free PSA, and p2PSA) into a single score.

In this study of 253 men, Carter, Schwen and Mamawala showed that, while “both of these tests are useful on their own in predicting progression of prostate cancer, when used together, their value is additive and more powerful,” says Schwen. They found that together, PHI and mpMRI “can be used to rule out unfavorable-risk disease with near-perfect certainty in select patients.” In fact, they estimate, “these tests together can help reduce the number of prostate biopsies performed in active surveillance by nearly 20 percent.”

These findings were presented recently at the American Urologic Association and European Urological Association conferences.