Transcript Prostate Cancer Screening

Prostate Cancer Screening
Assistant Professor Charles Chabert
Men’s health Seminar
Ballina
April 2011
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What is the Prostate?
Walnut sized gland under
the bladder
Shaped like a dognut
Part of the male
reproductive system
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What is Prostate Cancer?
• Malignant growth within the prostate
• Grows independently of normal body
regulatory processes
• Has the ability to spread to other systems
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How common is Prostate cancer?
• Increasing incidence over the last 2 decades
• Around 20 000 new diagnoses each year
• Around 3000 deaths annually
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What are the Risk Factors?
• Age
• Family History
• Race
• Diet
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How is it detected?
• Prostate cancer is aymptomatic: development
of urinary symptoms is a late feature
• Detected by combination of digital exam and
PSA test
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The PSA Test
• PSA (Prostate Specific Antigen) is produced
by the prostate
• Function of prostate is to liquify semen
• PSA Binds to serum proteins in the blood
stream
• PSA is currently the best serum marker for
prostate cancer
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Why should you perform a DRE?
• An important part of screening
• Despite normal PSA, 25% of men with a
abnormal DRE have prostate cancer
Digital Rectal Examination
Catalona WJ et al. 1994
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What are the Presenting Symptoms?
• Localised disease is generally
asymptomatic as the majority of
cancers are located in the
peripheral zone.
• Symptoms of LUTS are usually due
to BPH, enlargement of the
transitional zone.
• In locally advanced disease, large
cancer volume may cause LUTS.
Why should you perform a DRE?
• An important part of screening
• Despite normal PSA, 25% of men with a
abnormal DRE have prostate cancer
Digital Rectal Examination
Catalona WJ et al. 1994
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To Screen or Not To Screen


For Testing
• Tests are simple (PSA, DRE)
• Detects cancer earlier,
increasing chance of cure.
• Treating early CaP with surgery
does improve survival
• Reassurance for patients with
negative results
Against Testing
• False-positives cause anxiety
and further testing
• Cancers can be missed
• Expensive and time-consuming
• Indolent cancers may be
unnecessarily treated
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Evidence as it stands
• ERSCP 12 year data
• 31.2% relative reduction in metastatic disease
• Swedish study shows 50% reduction in CAP
mortality over 14 years
• 293 invited to screen
• 12 diagnosed to prevent 1 CAP death
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Is this PSA normal?
Age
Median PSA
Normal Range
40-49
0.7ng/ml
0-2.5ng/ml
50-59
0.9ng/ml
0-3.5ng/ml
60-69
1.4ng/ml
0-4.5ng/ml
70+
0-6.5ng/ml
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Catalona AUA 2005 Abs 953, Oesterling JE et al 1993
Risk of Prostate Cancer in Asymptomatic Men
with Normal DRE?
PSA Levels (ng/ml)
Risk of Prostate
Cancer in
asymptomatic men
1.1- 2.0
17%
2.1- 3.0
24%
3.1- 4.00
27%
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Adapted from Thompson, IM et al 2004
The Diagnosis
TRUS-guided biopsy of prostate
• TransRectal
Ultrasound (TRUS)
guided biopsy
performed under
local anaesthetic
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Take Home Points
• Lifestyle modification
• PSA screening reduces the risk of dying from
prostate cancer & reduces the risk of
metastatic disease
• Urological Society recommendations: test
from age 40years
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Questions?
The Prostate Clinic
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@Drcchabert