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Prostate Cancer Screening

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vicentiu2003
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14 views

Prostate Cancer Screening

aa4

Uploaded by

vicentiu2003
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Prostate Cancer Screening…. Why so controversial?

1. Prostate Cancer is very common but in most cases does not affect
survival
2. Screening with PSA greatly increased the number of cases being
diagnosed with very little survival benefit
3. Treatment options have significant side effects and expense

Prostate Cancer, How serious Is it?


More People Die with it than of it (by 20 X) •
Cancer in Gland at autopsy (80) 59%
Odds diagnoses with prostate cancer 11.6%
Odds of dying of prostate cancer 2.45%

Prostate Cancer Screening…. On the other hand


1. It is the second leading cancer killer in men and can’t be ignored
2. Need to discriminate more carefully who needs to be biopsied
3. Need to better discriminate which cancers need treatment
4. Need to improve treatments options

What’s the status of screening?


2. Increasing role of MRI in staging and biopsy
3. Increasing use of Genomics in prognosis
4. Basic Treatment options
5. New drug agents

Age 55 – 69: Discuss it 70 or older: Don’t


Screening may reduce the risk of prostate cancer mortality, but is
associated with harms including false-positive biopsy results, biopsy
complications, overdiagnosis in 20 – 50%
• Early, active treatment may reduce the risk of metastatic disease,
although the long-term impact of early active treatment on prostate cancer
mortality remains unclear
• Active treatment is associated with sexual and urinary difficulties.

Prostate-Cancer Mortality at 11 Years of Follow-up . Schroder NEJM


2012:366, 981. European Randomized Study of Screening for Prostate
Cancer (ERSPG) Relative reduction in prostate cancer mortality was 29%
but absolute reduction was 1.07 deaths per 1000 men screened. To prevent
one death from prostate cancer at 11 years of follow-up, 1055 men would
need to be invited for screening and 37 cancers would need to be detected.
There was no significant between-group difference in all-cause mortality.

What is a Normal PSA Score?


• Median for man 40 -49 (0.7) • 50-59 (0.9)
• a rise of > 0.75 in one year is worrisome ,
• Men up to 60 with PSA < 1 rarely have serious cancer and
• men 75 with 3 or less rarely serious.
• Drugs (avodart, proscar, flomax , saw palmetto, lower the PSA)

Screening Age 45 to 75 y PSA < 1 Repeat at 2 to 4 year interval


PSA 1 – 3 Repeat every 1 to 2 years
PSA > 3 or suspicious DRE Consider Biopsy
If over 75 and healthy consider testing and if over 4 consider biopsy

In the PCPT trial PSA


Cancer < 4 15%
4 – 10 30 – 35% > 10 67%

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