Transcript Update on Prostate Cancer

Update on Prostate Cancer
Senthil Kumaar
GP VTS teaching
Overview

Background & Statistics

Scenario 1 - Diagnosis & PSA testing

Scenario 2 – possible treatment options

Scenario 3 – important complications that
we should know

Summary
Background & Stats
How common is it ?
- Commonest cancer in men (25 % of all cancers in
men)
- 2nd commonest cancer death after lung in men
What are the risk factors ?
- Age
- Ethinicity – Black african/caribbean > White >
south Asian
- Family history
- BRCA gene mutation
No modifiable risk factors
Incidence
EU 27 – Age standardised incidence
and mortality rates
Trend
Age at diagnosis
Mortality rates
Office for National Statistics. Cancer Statistics Registrations, England
PSA screening – What’s the
evidence?
European RCT (ERSPC) – 9 yr interim results
 US study (PLCO) – 10 yr interim results

Number Needed to Screen (NNS) - 1400 men to
prevent one Pca death
Number needed to treat (NNT) – 48 men to
prevent one Pca death
UK verdict – No evidence that Benefits outweigh
harms
GP Scenario 1

60 yr old requesting PSA test
History ?
Counselling ??
Benefits & Harm of PSA testing
Benefits – early detection – early treatment - ? Extent
life / cure
Harms
 Unnecessary anxiety – only 1 in 3 with high PSA will
have Pca
 Unnecessary investigations – biopsy / imaging, only 1
in 3 of Pca are likely to be clinically significant
 Unnecessary treatment – may lead to treatment of
insignificant cancer which would not have clinically
evident in the man’s lifetime.
 False reassurance – 2 out of 10 may have normal PSA
and still have cancer.
When to suspect Pca ?
Unexplained
 Lower back pain
 Bone pain
 Wt loss in elderly
 ED
 Haematuria
Abnormal DRE
Raised PSA
When to offer PSA ?
Men > 50 , who ask for it
 Men with unexplained symptoms
 Men with obstructive LUTS

When to do PSA test ?
4 weeks after infection
 1 week after DRE
 48 hrs after exercise/ / ejaculation

Don’t forget DRE
www.prosdex.com
Counselling aid during consultation
Gp Scenario 2 – pt requesting your
opinion on treatment options
Gp Scenario 3 – pt presenting with
complications of Pca
Medical Emergency
- Spinal cord compression
- Acute / chronic retention
Summary





Increased incidence due to better diagnosis, but no
significant change in mortality rate
PSA national screening (UK policy) – Harm outweigh
benefits
Opportunistic PSA screening after appropriate
counselling
All treatment options have adverse effects including
active surveillence
All these might change in near future – UK 15 yr study
(ProTect trial) are publishing their results next year
(2013).