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Prostate health


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Prostate health

  1. 1. Dr Ling Sien Ngan Anti Aging, Aesthetic Medical Practitioner
  2. 2. PSA ---The Prostate <ul><li>Prostatic Seminal Antigen [in short called PSA] </li></ul>
  3. 3. Normal anatomy of prostate
  4. 4. <ul><li>Prostate cancer is the most common malignant tumor. </li></ul><ul><li>Unlike BPH, prostate cancer not only enlarge it also spread to other parts of body. </li></ul><ul><li>This disease is by simple transfer of cancer cells directly to other parts through a local plexus of vein. </li></ul>
  5. 5. Nornal PSA – S’pore context <ul><li>Current normal=0 – 4.0 mmol/dl </li></ul><ul><li>Is based on 90% CI(confidence interval) </li></ul><ul><li>There is trend in detecting significant cancer in pt with PSA 2.5—4.0 </li></ul>
  6. 6. terminology <ul><li>PSA density=PSA/prostate volume, by u/s </li></ul><ul><li>PSA velocity=rate of change of PSA </li></ul><ul><li>Age specific PSA---to age gp </li></ul>
  7. 7. Who should have PSA test <ul><li>Part of evaluation for BPH </li></ul><ul><li>Family history of CA prostate </li></ul><ul><li>.2 yrly for 40-50yr old </li></ul><ul><li>. Yrly for those > 50 yr </li></ul><ul><li>Abnormal DRE </li></ul><ul><li>Pt request </li></ul>
  8. 8. N PSA ---USA context <ul><li>In USA normal=0– 2.5 mmol/dl </li></ul><ul><li>There is trend in lowering normal range </li></ul><ul><li>Some tumor(25%) are found in range 2.5—4.0 </li></ul>
  9. 9. PSA source <ul><li>PSA is excreted exclusively by prostate during cancer , infection, injury, BPH </li></ul><ul><li>Higher PAS with larger vol. prostate---no risk </li></ul><ul><li>Higher PSA with smaller vol. prostate—CA risk </li></ul>
  10. 10. PSA velocity <ul><li>Normal= 0.75 ng/dl/yr </li></ul>
  11. 11. PSA in elderly <ul><li>PSA increase with age, incidence of CA prostate increase with age </li></ul><ul><li>Below 70yr :PSA above 4.0 –do prostate Bx </li></ul><ul><li>Above 70 :PSA above 4.0 –may not Bx unless grossly raised </li></ul>
  12. 12. Rate of prostate CA growth <ul><li>Most prostate CA grow very slowly —so don’t do Bx for every one </li></ul><ul><li>MODERATE GRADE CA PROSTATE : .remain symptom free for 3yr .when given hormonal treatment , symptom free another 2 yr .after completed hormone treatment, it go into hormone refractory period- ---giving further 2 yr symptom free </li></ul><ul><li>Total 7 yr symptom free </li></ul>
  13. 13. Eg ,if CA prostate at 75 yr <ul><li>Die at 75+7 yr =82 -old enough. </li></ul><ul><li>Life expectancy of S’pore men=76 yr </li></ul>
  14. 14. Very high PSA <ul><li>PSA above 20 mmol/dl– indicate metastasis---confirm by CT & bone scan </li></ul><ul><li>PSA 20 – 30 ,with –ve CT & bone scan –indicate microinvasive CA,or micrometastasis </li></ul>
  15. 15. Retreating PSA <ul><li>CA never regress itself </li></ul><ul><li>If PSA decrease from 10 to 5(post antibiotic) – .indicate purely inflamation OR .inflamation + CA </li></ul>
  16. 16. PSA returning to normal <ul><li>Total removal of prostate :within 1 wk normalize </li></ul><ul><li>After antibiotic for prostate infection: normalize in 3 wk (quinolone, cephalosporin, sulphanamide) </li></ul>
  17. 17. Significance of PSA decrease with age <ul><li>Do PSA for every one below 70 yr with BPH </li></ul>
  18. 18. Family H/O CA prostate <ul><li>Significance if die less than 60 yr </li></ul><ul><li>Insignificance if die more than 60 yr </li></ul>
  19. 19. General large scale PSA screening <ul><li>Not recomended </li></ul>
  20. 20. DRE & PSA <ul><li>No matter how you do DRE ,it never affect PSA (unless instrumentation,yes) </li></ul><ul><li>PSA, like liver enzyme(alk phosphatase) are not to be in circulation </li></ul>
  21. 24. Promote Positive Ageing <ul><li>Acceptance of ageing </li></ul><ul><li>empowerment </li></ul><ul><li>individuality </li></ul><ul><li>physical activity </li></ul><ul><li>social contact/friendship </li></ul><ul><li>developing coping skills </li></ul><ul><li>valuing experience, knowledge etc. </li></ul><ul><li>Denial of ageing </li></ul><ul><li>disempowerment </li></ul><ul><li>being stereotyped </li></ul><ul><li>sedentary lifestyle </li></ul><ul><li>social withdrawal </li></ul><ul><li>psychological stress </li></ul><ul><li>overvaluing paid work </li></ul>Ee Brendan Kennelly Encourage Avoid
  22. 25. If ageing can be halted... Ee The Lost Horizon Would you choose to be in it?
  23. 26. SEEKING A GOOD LIFE STYLE ? <ul><li>Physically and emotionally strong </li></ul><ul><li>Age gracefully </li></ul><ul><li>Feel good factor </li></ul>
  24. 28. Be all that you are. Show it off <ul><li>VIBRANT </li></ul><ul><li>RADIANT </li></ul><ul><li>VITALITY </li></ul>
  25. 29. Thank you for your attention !