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screening for Prostate cancer

screening for Prostate cancer. M Ravanbod Medical oncologist Bushehr – 11/91. A 50 y/o white man comes for check up and wants to discuss about prostate cancer. Negative family history No lower urinary tract symptoms What would you advise?. Most frequent non-skin cancer

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screening for Prostate cancer

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  1. screening for Prostate cancer M Ravanbod Medical oncologist Bushehr – 11/91

  2. A 50 y/o white man comes for check up and wants to discuss about prostate cancer. • Negative family history • No lower urinary tract symptoms • What would you advise?

  3. Most frequent non-skin cancer • Second leading cause of cancer death • About 250,000 new cases anually • About 34,000 deaths/yr • After peaking in early 1990s about 30% decrease till 2007 • After 2007 at diagnosis 80% confined to prostate ,4% metastatic

  4. Risk factors • Older age • Positive family history • Black race • Median age at diagnosis is 67.

  5. In the US 90% detected by screening • After introduction of PSA lifetime diagnosis doubled ;9% in 1985;16% in 2007 • Great majority of men with a diagnosis of prostate cancer die from other causes • Autopsy data suggests 30% of men>50y and 70% >70y have occult prostate cancer.

  6. SEER registry data • 90,000 prostate cancer 1992-2002 • Death risk from prostate cancer: 8% for well-diff. tumors 26% for poorly-diff. • Death risk from other causes:60%

  7. Screening • The rationale for screening is that early detection and treatment of asymptomatic cancers could extend life, as compared with treatment at the time of clinical diagnosis.

  8. Effective screening requires: - an accurate,reliable,easy to administer test that detects clinically important cancers at a preclinical stage. -availability of effective treatment that results in better outcomes when administered early.

  9. For many years DRE was the primary screening test for prostate cancer • In the late 1980s PSA widely adopted for screening. • There was no evidence that testing reduced the risk of death from prostate cancer

  10. False positive PSA • BPH • prostatitis • Cystitis • Ejaculation • Perineal trauma • Recent urinary tract instrumentation or surgery

  11. False negative • In prostate cancer prevention trial: -15% of men with normal DRE and PSA= 4 had prostate cancer - 9% in nl DRE and PSA< 1

  12. Approaches to improve the diagnostic accuracy of PSA test • Measuring PSA velocity • Free & pr-bound PSA • PSA density • Use of cutoff values for age & race • However,the clinical usefulness of these strategies remains unproved.

  13. ERSPC trial • 7 europian countries • 182,160 men between 50-74y • Prostate cancer 8.2% in screen group vs 4 .8% in control group • Mortality from prostate cancer was 20% lower in screen group, not for 50-54 & 70-74 y

  14. PLCO trial • In US , 76693 men between 55-74 y • PSA & DRE annually for 6 yrs • 22% more cases detected in screen group • Did not show any reduction in overall or prostate cancer mortality

  15. US Preventive Services Task Force • Recently issued a draft recommendation against PSA screening for asymptomatic men, regardless of their age,race or family history • The Task Force concluded that the harms of screening outweigh the benefits.

  16. conclusion • Decision about prostate cancer screening should be based on the preferences of an informed patient.

  17. ACS guidelines • Shared decision making between patient and physician • Age to begin: - average risk :50 (40 in AUA) - high risk (black or 1st degree relative with prostate cancer) : 40-45 (40 in AUA) • Discontinuation of screening: life expectancy <10 yr

  18. Screening tests: PSA , DRE(optional) • Frequency : annual (every other yr if PSA<2.5) • Criteria for biopsy:PSA>4.abnormal DRE. Individualize risk assessment if PSA = 2.5-4

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