This document discusses screening and biopsy for prostate cancer. It provides information on:
1. The imperfect nature of PSA screening and the risks of overdiagnosing low-grade prostate cancer through unnecessary biopsies and overtreatment.
2. Factors that can help determine the likelihood of finding cancer on biopsy for men with elevated PSA levels, such as prostate size, family history, and PCA3 urine tests.
3. Imaging options like MRI that may improve accuracy and allow targeted biopsies to avoid unnecessary procedures.
This document discusses prostate cancer awareness and provides information about prevention, symptoms, treatment options and stages. It notes that prostate cancer is the second leading cause of cancer death in American men and that early detection is vital for survival. It describes exams like the digital rectal exam and PSA testing that are used to detect prostate cancer early before symptoms appear. If cancer is found, it explains treatment options depending on the stage, like watchful waiting, surgery, radiation and hormone therapy. It stresses the importance of education and consulting doctors to make informed healthcare decisions.
We urge men and male cancer Survivors to encourage one another to invest in their health through regular self-examinations, getting screened and adopting a balanced lifestyle, in order to reduce their cancer risk or the recurrence of cancer.
CANSA places the focus on Prostate and Testicular Cancer during its Men’s Health Awareness Campaign in November.
Read more: http://www.cansa.org.za/mens-health/
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
Prostate cancer is a relatively common cancer in men over 60. If not treated early, it can spread from the prostate to bones and lymph nodes. Symptoms may include bone pain, urinary problems, erectile dysfunction, pelvic discomfort, and weak urine stream. Services offered to treat prostate cancer include radiation therapy, hormonal treatment, surgical removal of the testicles or prostate gland, and transurethral resection of the prostate. Men experiencing symptoms should book an appointment with a urologist.
Screening for prostate cancer using PSA has several limitations. It It is an organ specific marker, however, pathology specificity is low (elevated in all, prostatitis, prostatomegaly, prostate cancer, prostate manipulation). Attempts have been made to improve specificity while retaining its sensitivity, e.g. PSA density, PSA % free, PSA velocity, prostate health index (which takes into account p2PSA as well).
after diagnosis of prostate cancer, PSA doubling time is used for assessment of indication of treatment for patients on active surveillance as well as that for indication of salvage treatment for patients with biochemical recurrence after initial treatment.
1) The accuracy of the PSA test for detecting prostate cancer depends on the age of the patient and the prevalence of prostate cancer, which increases significantly with age.
2) For patients under 70 years old, the PSA test has very low accuracy, ranging from near 0% to 22% accuracy, which could lead to many unnecessary invasive biopsies.
3) The U.S. Preventive Services Task Force recommends against PSA-based prostate cancer screening for men 75 and older, and makes no recommendation for men under 75 due to inadequate evidence that screening improves health outcomes.
This document discusses prostate cancer awareness and provides information about prevention, symptoms, treatment options and stages. It notes that prostate cancer is the second leading cause of cancer death in American men and that early detection is vital for survival. It describes exams like the digital rectal exam and PSA testing that are used to detect prostate cancer early before symptoms appear. If cancer is found, it explains treatment options depending on the stage, like watchful waiting, surgery, radiation and hormone therapy. It stresses the importance of education and consulting doctors to make informed healthcare decisions.
We urge men and male cancer Survivors to encourage one another to invest in their health through regular self-examinations, getting screened and adopting a balanced lifestyle, in order to reduce their cancer risk or the recurrence of cancer.
CANSA places the focus on Prostate and Testicular Cancer during its Men’s Health Awareness Campaign in November.
Read more: http://www.cansa.org.za/mens-health/
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
Prostate cancer is a relatively common cancer in men over 60. If not treated early, it can spread from the prostate to bones and lymph nodes. Symptoms may include bone pain, urinary problems, erectile dysfunction, pelvic discomfort, and weak urine stream. Services offered to treat prostate cancer include radiation therapy, hormonal treatment, surgical removal of the testicles or prostate gland, and transurethral resection of the prostate. Men experiencing symptoms should book an appointment with a urologist.
Screening for prostate cancer using PSA has several limitations. It It is an organ specific marker, however, pathology specificity is low (elevated in all, prostatitis, prostatomegaly, prostate cancer, prostate manipulation). Attempts have been made to improve specificity while retaining its sensitivity, e.g. PSA density, PSA % free, PSA velocity, prostate health index (which takes into account p2PSA as well).
after diagnosis of prostate cancer, PSA doubling time is used for assessment of indication of treatment for patients on active surveillance as well as that for indication of salvage treatment for patients with biochemical recurrence after initial treatment.
1) The accuracy of the PSA test for detecting prostate cancer depends on the age of the patient and the prevalence of prostate cancer, which increases significantly with age.
2) For patients under 70 years old, the PSA test has very low accuracy, ranging from near 0% to 22% accuracy, which could lead to many unnecessary invasive biopsies.
3) The U.S. Preventive Services Task Force recommends against PSA-based prostate cancer screening for men 75 and older, and makes no recommendation for men under 75 due to inadequate evidence that screening improves health outcomes.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
The PSA test measures levels of prostate-specific antigen in the blood to screen for prostate cancer. High PSA levels could indicate prostate cancer but can also be caused by other prostate conditions. There is conflicting advice about PSA testing and whether a man should get tested depends on discussing risks and benefits with their doctor. In addition to a PSA test, doctors may perform a digital rectal exam to check the prostate for abnormalities. The US Preventive Services Task Force currently recommends against PSA screening because many men are harmed by overtreatment while few benefit, as better tests and treatments are still needed.
This document summarizes statistics on prostate cancer incidence and mortality rates in the United States from 1975 to 2009. It also discusses results from several major clinical trials comparing prostate cancer screening to no screening, and radical prostatectomy to observation for localized prostate cancer. The key findings are:
1) Prostate cancer incidence peaked in 1992 but mortality rates have been declining since the 1990s.
2) Large screening trials show screening increases prostate cancer diagnosis but does not reliably decrease prostate cancer mortality.
3) The PIVOT trial found that among men with localized prostate cancer, radical prostatectomy resulted in a 2.9% lower rate of death from any cause and a 2.6% lower rate of death from prostate
Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.ur...nataliejleigh
This document provides information about prostate cancer testing and treatment options. It discusses what the prostate is, risk factors for prostate cancer, common screening tests like the PSA test and digital rectal exam, biopsy procedures, and treatment options including active surveillance, surgery, radiation therapy, and other approaches. The goal is to help patients make informed decisions by understanding their diagnosis and available options.
Role of Prostate Specific Antigen in Benign and malignant prostatic lesions S ghazal
PSA, or prostate-specific antigen, is a protein produced by the prostate gland that is often elevated in prostate cancer and other prostate conditions. PSA levels above 4 ng/ml are considered abnormal and could indicate prostate cancer or benign conditions like BPH. While PSA screening has helped detect prostate cancer early and reduce mortality rates, it can produce false positives and negatives. The percentage of free PSA versus total PSA is lower in prostate cancer patients compared to those with benign conditions. Serial PSA measurements are useful for monitoring treatment response and detecting disease recurrence.
This document discusses cancer screening guidelines for several common cancers. It recommends screening for breast cancer with annual mammograms and clinical exams starting at age 40, and beginning earlier or including MRI for those at high risk. Cervical cancer screening should begin at age 21 with Pap tests every 3 years or co-testing with HPV every 5 years. Colorectal cancer screening options include colonoscopy every 10 years, sigmoidoscopy every 5 years, or annual fecal tests. Genetic screening is recommended for those with a family history suggesting inherited cancer risk. Lung cancer screening with low-dose CT is advised for high-risk smokers aged 55-74. Prostate cancer screening involves PSA testing and DRE for men aged 50-69
Molecular biology of Prostate cancer. There are three major pathways - the androgen receptor pathway, PI3K/Akt pathway, and Rb pathway. Other factors include TMPRSS2-ETS fusion, TGF-b1, PTEN loss, and aberrant E-cadherin expression. Risk factors include age, ethnicity, genetic mutations like BRCA1/2, and environmental exposures. Prostate cancer can metastasize, with bone and lymph nodes being common sites. Diagnosis involves tests like DRE, PSA, biopsy, and imaging. Hormone therapy targets the androgen receptor and includes surgical or medical castration as well as antiandrogens, but resistance eventually develops
This document discusses prostate cancer screening, diagnosis, staging, and treatment options. It covers PSA testing and digital rectal exams for screening. Biopsies and PSMA PET scans are used for diagnosis and staging. Risk stratification helps determine treatment, which may include radical prostatectomy, radiotherapy, hormone therapy drugs like abiraterone acetate and enzalutamide, chemotherapy like docetaxel, or bone-directed drugs for metastases. Complications of prostatectomy include blood transfusions, infections, incontinence, and erectile dysfunction. Radiotherapy and hormone therapies can cause side effects like fatigue, fluid retention, and liver enzyme changes.
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This document discusses the numerous variables involved in prostate cancer treatment decisions. It covers factors like risk level, treatment options for newly diagnosed, recurrent, and advanced prostate cancer. It also addresses how patient characteristics, relationships, personality, and understanding of statistics can influence decisions. Additionally, it outlines the many uncertainties in prostate cancer like rapid technology changes, limitations of studies and doctors, and potential profit motives. The conclusion is that prostate cancer requires considering a man's overall health, relationships, and quality of life when determining the often complex management options.
What are the problems with transrectal biopsies of the prostate for prostate ...Marc Laniado
Transrectal prostate biopsies carry risks of infection in 1-4% of men and can underestimate or miss cancers at the front of the prostate. Unguided biopsies may incorrectly interpret a small cancer as more significant or fail to fully represent an important cancer. An ideal biopsy would accurately target cancers without risk of infection.
Learning about prostate cancer by exampleGil Lederman
This document presents the case study of a 65-year-old man diagnosed with prostate cancer who underwent radical prostatectomy surgery despite warnings from the author about its risks and limited success rates. The surgery found the cancer had a higher Gleason score than initially detected and had spread beyond the prostate. As a result, the man lost sexual function and faces a high risk of cancer recurrence. The author argues radiation therapy could have achieved better outcomes for this patient based on their superior data for cancer-free survival and sexual function preservation. The case highlights the importance of fully investigating all treatment options before making decisions.
This document provides information about prostate cancer, including:
- It is a cancer that occurs in the prostate gland and is one of the most common cancers in men. While some types grow slowly, others can spread quickly.
- Risk factors include age, family history, and race. Many times it causes no symptoms but can sometimes cause urinary or sexual issues.
- Diagnosis involves exams, blood tests, and biopsies. Treatment depends on stage but can include surgery, radiation, hormone therapy, chemotherapy, and active surveillance. Complications may include incontinence and erectile dysfunction. Prevention focuses on diet, exercise, and weight control.
Prostate cancer - diagnosis using prostate cancer risk calculators, multiparametric MRI, MRI-targeted transperineal prostate biopsies using software registration
Cancer screening - Evidence, Expected benefits, Methods and Current Recommend...Alok Gupta
This document provides information about cancer screening and recommendations for different types of cancer. It discusses the major cancers in India like breast, cervical, colon, oral, lung and prostate cancer. For each cancer, it covers epidemiology, screening methods, benefits and recommendations. Screening can detect cancers early and reduce cancer deaths. Regular screening is recommended for certain populations based on risk factors like age, gender and family history. The key screening tests discussed are mammography, Pap smear, fecal occult blood test, colonoscopy, visual oral exam, low-dose CT scan and PSA testing. Screening can detect breast, cervical and colon cancers early and reduce deaths by 30%, 70% and 25% respectively.
1 introduction to the intel challenge mena PotentialCom
A brief introduction to Intel, the Intel Global Challenge, the Intel Regional MENA Challenge; Understand Potential's role and support in this challenge
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
The PSA test measures levels of prostate-specific antigen in the blood to screen for prostate cancer. High PSA levels could indicate prostate cancer but can also be caused by other prostate conditions. There is conflicting advice about PSA testing and whether a man should get tested depends on discussing risks and benefits with their doctor. In addition to a PSA test, doctors may perform a digital rectal exam to check the prostate for abnormalities. The US Preventive Services Task Force currently recommends against PSA screening because many men are harmed by overtreatment while few benefit, as better tests and treatments are still needed.
This document summarizes statistics on prostate cancer incidence and mortality rates in the United States from 1975 to 2009. It also discusses results from several major clinical trials comparing prostate cancer screening to no screening, and radical prostatectomy to observation for localized prostate cancer. The key findings are:
1) Prostate cancer incidence peaked in 1992 but mortality rates have been declining since the 1990s.
2) Large screening trials show screening increases prostate cancer diagnosis but does not reliably decrease prostate cancer mortality.
3) The PIVOT trial found that among men with localized prostate cancer, radical prostatectomy resulted in a 2.9% lower rate of death from any cause and a 2.6% lower rate of death from prostate
Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.ur...nataliejleigh
This document provides information about prostate cancer testing and treatment options. It discusses what the prostate is, risk factors for prostate cancer, common screening tests like the PSA test and digital rectal exam, biopsy procedures, and treatment options including active surveillance, surgery, radiation therapy, and other approaches. The goal is to help patients make informed decisions by understanding their diagnosis and available options.
Role of Prostate Specific Antigen in Benign and malignant prostatic lesions S ghazal
PSA, or prostate-specific antigen, is a protein produced by the prostate gland that is often elevated in prostate cancer and other prostate conditions. PSA levels above 4 ng/ml are considered abnormal and could indicate prostate cancer or benign conditions like BPH. While PSA screening has helped detect prostate cancer early and reduce mortality rates, it can produce false positives and negatives. The percentage of free PSA versus total PSA is lower in prostate cancer patients compared to those with benign conditions. Serial PSA measurements are useful for monitoring treatment response and detecting disease recurrence.
This document discusses cancer screening guidelines for several common cancers. It recommends screening for breast cancer with annual mammograms and clinical exams starting at age 40, and beginning earlier or including MRI for those at high risk. Cervical cancer screening should begin at age 21 with Pap tests every 3 years or co-testing with HPV every 5 years. Colorectal cancer screening options include colonoscopy every 10 years, sigmoidoscopy every 5 years, or annual fecal tests. Genetic screening is recommended for those with a family history suggesting inherited cancer risk. Lung cancer screening with low-dose CT is advised for high-risk smokers aged 55-74. Prostate cancer screening involves PSA testing and DRE for men aged 50-69
Molecular biology of Prostate cancer. There are three major pathways - the androgen receptor pathway, PI3K/Akt pathway, and Rb pathway. Other factors include TMPRSS2-ETS fusion, TGF-b1, PTEN loss, and aberrant E-cadherin expression. Risk factors include age, ethnicity, genetic mutations like BRCA1/2, and environmental exposures. Prostate cancer can metastasize, with bone and lymph nodes being common sites. Diagnosis involves tests like DRE, PSA, biopsy, and imaging. Hormone therapy targets the androgen receptor and includes surgical or medical castration as well as antiandrogens, but resistance eventually develops
This document discusses prostate cancer screening, diagnosis, staging, and treatment options. It covers PSA testing and digital rectal exams for screening. Biopsies and PSMA PET scans are used for diagnosis and staging. Risk stratification helps determine treatment, which may include radical prostatectomy, radiotherapy, hormone therapy drugs like abiraterone acetate and enzalutamide, chemotherapy like docetaxel, or bone-directed drugs for metastases. Complications of prostatectomy include blood transfusions, infections, incontinence, and erectile dysfunction. Radiotherapy and hormone therapies can cause side effects like fatigue, fluid retention, and liver enzyme changes.
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This document discusses the numerous variables involved in prostate cancer treatment decisions. It covers factors like risk level, treatment options for newly diagnosed, recurrent, and advanced prostate cancer. It also addresses how patient characteristics, relationships, personality, and understanding of statistics can influence decisions. Additionally, it outlines the many uncertainties in prostate cancer like rapid technology changes, limitations of studies and doctors, and potential profit motives. The conclusion is that prostate cancer requires considering a man's overall health, relationships, and quality of life when determining the often complex management options.
What are the problems with transrectal biopsies of the prostate for prostate ...Marc Laniado
Transrectal prostate biopsies carry risks of infection in 1-4% of men and can underestimate or miss cancers at the front of the prostate. Unguided biopsies may incorrectly interpret a small cancer as more significant or fail to fully represent an important cancer. An ideal biopsy would accurately target cancers without risk of infection.
Learning about prostate cancer by exampleGil Lederman
This document presents the case study of a 65-year-old man diagnosed with prostate cancer who underwent radical prostatectomy surgery despite warnings from the author about its risks and limited success rates. The surgery found the cancer had a higher Gleason score than initially detected and had spread beyond the prostate. As a result, the man lost sexual function and faces a high risk of cancer recurrence. The author argues radiation therapy could have achieved better outcomes for this patient based on their superior data for cancer-free survival and sexual function preservation. The case highlights the importance of fully investigating all treatment options before making decisions.
This document provides information about prostate cancer, including:
- It is a cancer that occurs in the prostate gland and is one of the most common cancers in men. While some types grow slowly, others can spread quickly.
- Risk factors include age, family history, and race. Many times it causes no symptoms but can sometimes cause urinary or sexual issues.
- Diagnosis involves exams, blood tests, and biopsies. Treatment depends on stage but can include surgery, radiation, hormone therapy, chemotherapy, and active surveillance. Complications may include incontinence and erectile dysfunction. Prevention focuses on diet, exercise, and weight control.
Prostate cancer - diagnosis using prostate cancer risk calculators, multiparametric MRI, MRI-targeted transperineal prostate biopsies using software registration
Cancer screening - Evidence, Expected benefits, Methods and Current Recommend...Alok Gupta
This document provides information about cancer screening and recommendations for different types of cancer. It discusses the major cancers in India like breast, cervical, colon, oral, lung and prostate cancer. For each cancer, it covers epidemiology, screening methods, benefits and recommendations. Screening can detect cancers early and reduce cancer deaths. Regular screening is recommended for certain populations based on risk factors like age, gender and family history. The key screening tests discussed are mammography, Pap smear, fecal occult blood test, colonoscopy, visual oral exam, low-dose CT scan and PSA testing. Screening can detect breast, cervical and colon cancers early and reduce deaths by 30%, 70% and 25% respectively.
1 introduction to the intel challenge mena PotentialCom
A brief introduction to Intel, the Intel Global Challenge, the Intel Regional MENA Challenge; Understand Potential's role and support in this challenge
À l'appui de votre Business Model, vous avez besoin d'une attitude de gagnant tous autour de vous. Une fois vous sélectionnez les personnes ayant un engagement élevé, éthique, confiance et transparence, apprenez les étapes nécessaires pour l'inscription de l'équipe en ligne .
Upon defining the Business Model elements, plan how to attract sales & investments through well-defined Startup Costs; a solid Prototype; an effective Elevator Pitch, and Sales & Networking
This webinar covered the internal elements of a business model canvas, including key resources, key activities, key partners, and cost structure. Case studies of Apple's iPod-iTunes and Amazon's business model innovations were discussed. Participants were asked to plot their own business models using the canvas framework. The session aimed to help entrepreneurs design and align their business plans using the common business model canvas language.
Prostate cancer screening and early detection is an ongoing area of research and debate. While screening can detect prostate cancer earlier when it may be more treatable, it also leads to overdiagnosis and overtreatment. Several large clinical trials have had conflicting results on the benefits of prostate cancer screening. Guidelines from organizations also vary in their recommendations for screening. New biomarkers and imaging techniques are being studied to improve screening specificity and reduce unnecessary biopsies and treatment. Overall, the effectiveness of prostate cancer screening remains uncertain, and any decision to be screened requires informed discussion of risks and benefits.
This document provides an overview of prostate cancer, including who is affected, risk factors, detection methods like PSA testing and biopsy, staging using the Gleason score and TNM system, and treatment options like surgery, radiation therapy, active surveillance, and androgen blockade. It discusses outcomes for different treatments and challenges in managing prostate cancer recurrence after initial therapy.
Mon 8-00 Prostate Cancer Screening in the Post-USPSTF Era_0.pptxRonitEnterprises
This document discusses prostate cancer screening and recommendations. It begins with a case presentation of a 54-year-old man before discussing the US Preventive Services Task Force recommendations against PSA screening. It then reviews the goals of cancer screening, basics of PSA testing and prostate cancer, impact of the Task Force, and ways to improve screening through risk stratification using newer biomarkers, imaging, and genetic profiling to avoid overdiagnosis while identifying high-risk cancers.
Current Diagnosis And Management Of Prostate Cancerfondas vakalis
1) Prostate cancer risk factors include increasing age, family history, and lifestyle factors like smoking and high fat diets.
2) Screening methods include digital rectal exam and PSA testing, though screening recommendations vary.
3) Treatment options depend on cancer severity and include watchful waiting, surgery, radiation, hormone therapy, and cryotherapy. Long-term side effects can include incontinence and impotence.
Prostate cancer - Vincent Batista LemaireNiela Valdez
The document summarizes the PI-RADS (Prostate Imaging Reporting and Data System) guidelines for prostate imaging and reporting. It describes the goal of PI-RADS to standardize acquisition, interpretation, and reporting of prostate imaging globally. It also reviews techniques for prostate cancer screening and diagnosis including digital rectal exam, prostate-specific antigen testing, transrectal ultrasound biopsy, and multiparametric magnetic resonance imaging, and discusses the Gleason grading system for evaluating prostate cancer specimens.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. While screening may help reduce mortality by detecting cancer early, it can also lead to overdiagnosis and false positive results that cause unnecessary biopsies and treatments with side effects.
2) Guidelines from organizations like the U.S. Preventive Services Task Force and American Urological Association recommend shared decision making for men ages 55-69, as screening in this group balances a potential reduction in mortality with known harms. Screening is not routinely advised for men under 40 or over 70.
3) Trials show screening every 2 years may preserve benefits of screening while reducing overdiagnosis and false positives compared to annual screening. However,
This document provides an overview of prostate cancer including epidemiology, risk factors, screening recommendations, clinical presentation, diagnosis, staging and risk stratification. Some key points:
- Prostate cancer is the second most common cancer in men worldwide. Incidence and mortality increases with age.
- Risk factors include age, family history, metabolic syndrome, certain dietary factors and medications.
- Screening is recommended for men aged 55-69 with a PSA test and digital rectal exam. Screening intervals depend on PSA levels.
- Diagnosis involves PSA testing, digital rectal exam, and biopsy. Staging uses the Gleason score and TNM system to determine risk level and treatment options
This document summarizes information about prostate cancer, including statistics on incidence and mortality rates in the United States. It discusses various screening and treatment options for prostate cancer. Key points include: lifetime risk of developing prostate cancer is 16.2% for men; screening with PSA and digital rectal exam has not been proven to reduce mortality; watchful waiting or active surveillance are appropriate for very low or low risk prostate cancer depending on life expectancy; radical prostatectomy and radiation therapy offer similar cure rates for early stage disease but have different side effect profiles.
This document discusses cancer screening for seniors and whether it makes sense. It notes that reasons not to screen everyone include costs, potential harms from false positives or procedures, and factors related to life expectancy and health status. It provides examples of famous people who died of pancreatic cancer and notes that screening for pancreatic cancer is not recommended. It asks questions about the most common cancers, typical cancer ages, beneficial screening tests, and best screening advice. It discusses stopping screening at age 75 but continuing for those expected to live 10 more years. It provides resources on cancer screening guidelines.
1. The document discusses the debate around prostate cancer screening in elderly men over age 65, with arguments on both sides.
2. Screening may detect cancers early that would not have progressed or caused harm in a man's lifetime given his life expectancy. However, screening also risks overdiagnosis and overtreatment of biologically unimportant cancers.
3. Guidelines in the US do not recommend routine screening for low-risk, elderly patients due to the scientific uncertainties around the balance of benefits and harms. Patient-clinician discussion is important to make informed, individual decisions.
The document discusses prostate cancer facts that men over 40 should know. It explains that prostate cancer is the most common non-skin cancer in American men and the second leading cause of cancer death. While symptoms may not always be present, early detection through annual PSA tests and digital rectal exams starting at age 40 or age 45 for those with risk factors can help find prostate cancer early and increase chances of survival. The document provides information on risk factors like age, race, family history and diet to help men understand their risk and need for screening.
1. The document discusses whether prostate cancer screening should be recommended for elderly men over age 65 given the high prevalence of prostate cancer but also the slow growing nature in many cases and short life expectancy.
2. While screening can detect cancer early, it also risks overdiagnosing biologically unimportant cancers and subjects men to potential harms of treatment without clear benefits due to their age.
3. Guidelines in the US have differing recommendations regarding screening older men, reflecting the ongoing debate around the balance of risks and benefits in this population.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
The document provides information on developing clinical guidelines for prostate cancer screening using PSA testing. It includes requirements for effective screening programs, characteristics of the PSA test, results from two large randomized controlled trials (PLCO and ERSPC) on PSA screening, and considerations for formulating a screening guideline. A third summary discusses estimates of lead time and overdiagnosis from prostate cancer screening from three mathematical models, with lead times ranging from 5-7 years and overdiagnosis estimated at 23-42% of screen-detected cancers.
Screening for Prostate cancer has had many different opinions and much research has been conducted in the last 20 years. In this presentation we will discuss the current guidelines for proper screening and gain more insight into men’s health.
This seminar discussed screening for carcinoma of the prostate. It was chaired by Prof. C. S. Ratkal and co-chaired by Dr. M. Shivalingaiah. Dr. Prakash H. S. presented on various screening modalities including digital rectal examination (DRE), prostate-specific antigen (PSA) testing, prostate biopsy, and imaging. PSA testing combined with DRE is the most useful first-line screening approach. While screening can detect early-stage cancers, it also risks overdiagnosis and overtreatment of indolent tumors. The benefits and limitations of prostate cancer screening continue to be debated.
This document provides information about prostate cancer including:
1) It discusses what the prostate gland is and risk factors for prostate cancer such as age, family history, diet, and race. African American men and those with a family history have a higher risk.
2) Early detection through annual PSA tests and digital rectal exams starting at age 40 is key, as having cancer detected early dramatically improves survival rates.
3) It recommends seeing a doctor annually for PSA tests and rectal exams to screen for prostate cancer and catch it as early as possible to improve treatment options. Knowing individual PSA levels allows men to monitor their prostate health over time.
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
Similar to Module 5 Dr Scholz-Screening&Biopsy (20)
The document discusses different treatment options for prostate cancer based on risk categories and disease stage, emphasizing the importance of accurate risk assessment and monitoring disease progression to initiate appropriate treatment early. It also stresses maintaining physical fitness during treatment and combining therapies when possible to achieve the best outcomes.
Prostate cancer deaths have decreased 40% over the past 20 years due to early detection and treatment, earlier use of hormone blockade therapy, and new agents. Screening and treatment have improved 10-year survival rates for prostate cancer patients. Prostate cancer screening starts important discussions about health, but increased screening may lead to overdiagnosis and overtreatment. Other leading causes of death in men include heart disease, lung cancer, and infections like pneumonia. Preventive measures like vaccines, screening tests, exercise, and diet can reduce mortality from cancer and heart disease.
This document discusses testosterone inactivating pharmaceuticals (TIP), also known as androgen deprivation therapy (ADT), for treating prostate cancer. It provides details on 6 types of anti-testosterone therapies with varying levels of potency. TIP is used as preliminary treatment before radiation to reduce prostate size, as ancillary treatment with radiation or surgery to improve cure rates, and as standalone therapy for intermediate-risk, high-risk, or advanced disease. TIP is also used after PSA relapse or for second-line treatment after other therapies stop working. Side effects of TIP include bone loss, metabolic effects, sexual dysfunction, and increased risk of fractures. Strategies are discussed to prevent bone complications like osteopor
This document discusses various imaging modalities for prostate cancer including ultrasound, MRI, CT, bone scans, and PET scans. It provides details on what each modality images, its benefits and limitations. Key applications discussed include biopsy guidance, active surveillance, therapy planning, and follow-up of rising PSA levels. While each modality has advantages, the best option depends on a patient's individual clinical factors and risk level.
This document discusses the management of low risk prostate cancer. It outlines the natural history of untreated low risk prostate cancer and the problems of overdiagnosis and overtreatment. Active surveillance is presented as a management option for low risk prostate cancer, with the rationale being to avoid unnecessary treatment and preserve quality of life. Results from active surveillance studies show low rates of cancer progression and metastasis, with 62% free from intervention at 10 years in one study. Triggers for intervention on active surveillance like rising PSA, grade progression, or tumor volume increase are discussed.
The document discusses various treatment options for prostate cancer including brachytherapy, IMRT, proton therapy, and surgery. It provides details on complications and side effects for each option as well as 5-year cure rates from various studies. It also discusses active surveillance versus immediate treatment and compares the results of the PIVOT and Bill-Axelson trials that studied intermediate risk prostate cancer patients.
This document discusses treatment options for high-risk prostate cancer. It defines high-risk as PSA >20, Gleason score >7, stage >T2b, or two or more intermediate risk factors. Treatment options discussed include radiation plus testosterone inactivating pharmaceuticals (TIP), which generally has better outcomes than surgery alone. The addition of seed implants to radiation can further boost radiation doses to the prostate. Studies show seed implants combined with radiation and TIP can achieve cure rates of 88-95% for high-risk prostate cancer patients.
Dr. Myers presented on PSA relapse but did not use slides, instead providing an audio-only presentation available on Vimeo. The recording discusses PSA relapse in a sound-only format and remains valuable despite lacking visuals.
This document discusses treatments for advanced prostate cancer. It begins by describing androgen deprivation therapy as the first line treatment. It then discusses newer FDA-approved treatments since 2010 like cabazitaxel, abiraterone, and immunotherapy drug Provenge. The rest of the document focuses on chemotherapy drug Taxotere/docetaxel, providing details on its efficacy compared to other drugs in clinical trials, side effects, and promising combinations with other treatments like Avastin, carboplatin, and thalidomide. It also discusses other emerging treatments like cabazitaxel, curcustersin, and immunotherapy drug Provenge.
1. V. Screening and Biopsy
PCRI Mentor Class 2012
Mark Scholz MD
Executive Director, Prostate Cancer Research Institute
Medical Director, Prostate Oncology Specialists
2. In The Ideal World….
Prostate cancer screening tests would detect
high-grade cancer while failing to detect low-
grade disease
Treatment would eliminate prostate cancer
100% of the time without any side effects
Money would grow on trees…..
3. Siegel, CA 62:10, 2012
*Estimates are rounded to the nearest 10 and exclude basal and squamous cell skin cancers and in situ carcinoma
except urinary bladder
5. Good and Bad Types Basketball
Players
of Prostate Cancer
Various
Types of
Cats
6. Fifteen-Year Prostate Cancer Mortality Timeline
“The Bad Type”
200,000 men diagnosed late 90’s
80% 13% 7%
Local Therapy Hormone Therapy Active Surveillance
35% Relapse Hormone Resistance
occurs in 50%
70% have 70% die from
Hormone Bone metastasis prostate cancer
Treatment occur in 80%
28,000 in 2012
6
7. PSA Screening Totally Changed The Picture
Siegel, CA 62:10, 2012
Increased Diagnosis of Mostly
Low-Grade Prostate Cancer
Initiation of
PSA Testing
in 1987
8. PSA Screening Every Four Years
in 180,000 European Men
Schroder, New England Journal 366:981,2012
Xxxxxx
Xxxxxx
Xxxxxx
Risk
Xxxxxx
Xxxxxx
of
Xxxxx
Xxxxxx
Death
Xxxxxx
Xxxxxx
Xxxxx
Xxxxxx
xxxxx
10. Annual PSA Screening in 75,000 Men
In the United States
Andriole, New England Journal 360:1310, 2009
11. Lower Mortality Since PSA Screening Initiated in 1987
Hoffman, New England Journal 365:2013, 2012
Extra New Cases
Of Prostate Cancer
Diagnosed
Initiation of
PSA Testing
Earlier Diagnosis
of High-Grade
Prostate Cancer
12. U.S Preventive Services Task Force
• The magnitude of harms from screening (e.g., falsely
high PSA, psychological effects, unnecessary biopsies,
over diagnosis of indolent tumors) is “at least small.”
• The magnitude of treatment-associated harms (i.e.,
adverse effects of surgery, radiation and hormonal
therapy) is “at least moderate”—particularly because
of overtreatment among men with low-grade disease.
• The 10-year mortality benefit of PSA-based screening
is “small to none.”
• The overall balance of benefits and harms results in
“moderate certainty that PSA-based screening … has
no net benefit.”
13. PSA Screening Definitely Saves Lives,
But What about Over-Diagnosis?
• Prior to PSA (1987) 1 of 41 men died of PC (2.4%)
• In 2009, with screening and early treatment, the risk of
dying from PC is 1 of 53 (1.9%)
• However, this improved survival come at a price:
– 200,000 men are diagnosed annually instead of 90,000
– One million men have prostate biopsies annually
– 48 men get unnecessary treatment for each life saved by therapy
– Tens of thousands of men diagnosed with Low-Risk prostate cancer
undergo unnecessary treatment with a negative impact on sexual &
urinary function
14. Since the “Approval” of Active Surveillance in 2007
Surgery is……..UP!
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Xxxxxxxxxxxxxxxxxxxxxxxxxxx 14
xxxxxxxxxxxxxxxxx
15. Foolish Proposals for Slowing the Rush
to Overtreatment
1. Stop PSA testing altogether, the ostrich approach
– PSA is an inexpensive test that’s proven to saves lives; it
is here to stay
1. Simply stop over-treating by resolving to do more
active surveillance?
– The doctors who do biopsies and make the diagnosis
are action oriented, i.e., they are surgeons
– The general populace, when confronted with the shock
of a cancer diagnosis, naturally assumes prostate
cancer just as deadly as other cancers. Surgical removal
seems like the most logical way to proceed
16. Slowing the Onslaught
of Overtreatment
Stop Doing Mindless Biopsies
On Uninformed Patients
With PSA Between 4 to 10
18. Risks of Prostate Biopsy
• 1% risk of infection serious enough to require
hospitalization
• 1% risk of bleeding serious enough to require
transfusion
• Erectile dysfunction (with repeated biopsy)
• Changes in urinary function
• Biopsy does not appear to spread cancer
20. 20-Core Saturation Biopsy
Klein, J. of Urol. 184:1447, 2010
• Increased urinary symptoms that persisted 3
months after the biopsy
• Erectile dysfunction problems that resolved
one month after the biopsy (also with
standard biopsy)
21. Risks of Diagnosing of Low-Grade Cancer
• Unnecessary treatment:
– Impotence, incontinence, Peyronie’s disease,
Climactauria, Strictures
• Emotional meltdown:
– Heart Attack, Suicides
– Depression, anxiety
• Permanent change in self-image
• Insurance issues
22. Frightened to Death by a Cancer Diagnosis
New England Journal 366:14, 2012
Increased Risk of Suicide Prostate Skin Lung
First 3 Months 200% 40% 1100%
Months 3 to 12 100% 0% 500%
After One Year 100% 40% 200%
Fatal Heart Attack
First 3 Months 180% 20% 1100%
Months 3 to 12 40% 0% 400%
After One Year 0% 0% 60%
23. Chance of Cancer Diagnosis with
a Six-Core Biopsy and Normal PSA
Thompson, JNCI 98:529, 2006
PSA Level Cancer Diagnosis Rate
1 – 2 17%
2 – 3 24%
3 – 4 27%
24. Risk of Immediate Biopsy
• More than 20% chance of diagnosing low-grade
prostate cancer
• When diagnosed, the risk of unnecessary
treatment is 90%
• With surgery the risk of:
– Impotence is 50%
– Incontinence after surgery is 7%
– Peyronie’s disease is 16%
– Climacturia is
25. We Know that…
• The goal is not to diagnose all prostate cancer
– Most men over 50 harbor microscopic prostate cancer
– Shall we just biopsy everyone over 40 regardless of PSA?
– Shall we remove the prostates of all men over 40?
• The main goal is detecting and treating high-grade
cancer
• PSA is an imperfect test
– Varies widely from day to day as a result of human
physiology, recent sexual activity, infections, etc.
– PSA levels under 10 predict prostate gland size much better
than prostate cancer. Men with big prostate glands are
being discriminated against!
26. Very First Step: Recheck PSA
• PSA checked on separate days
– Up to 30% Stamey, J. of Urol. 155:1977, 1996
– Up to 20% Brawer, J. of Urol. 157:2183, 1997
• If PSA > 2.5 then:
– 23% were normal the following year
– 20% were normal the following two years
– 18% were normal the following three years
Ankerst, J. of Urol. 181:2071, 2009
27. Test of PSA Stability When Tested
Annually for 5 Years
Eastham, JAMA 289:2695,2003
28. X
X Xxxx
Digital Rectal X X
X Xx
Xx X
Examination X
X
X
X
X X
X X
X X
X X
X X
X X
X X
X X
X
X
X
X
X
X
29. Digital Rectal on Subsequent Testing
Ankerst, J. of Urol. 181:2071, 2009
• 70% of abnormal DRE became normal
the following year, even in patients with
prostate cancer
• More than half of those that became
normal remained normal in subsequent
years
30. Poor Predictive Value of an
Abnormal Rectal Examination
Catalona J. of Urol. 161:835, 1999
PSA Level % Diagnosed
0-1 5%
1 – 2.5 14%
2.5 - 4 30%
31. PSA “Velocity,” A Rising PSA Over Time
Loeb, J. of Urol. 178:2348, 2007
• 0.4 per year with PSA between 0 and 4
detects cancer more frequently
• 0.75 per year with PSA between 4 and 10
detects cancer more frequently.
• 2.0 per year detects cancers associated
with higher mortality –Next slide….
32. Low-Risk… But Fast PSA Velocity
D’Amico NEJM 351:125,2004
PSA Less than 2 More than 2
Velocity point /year points / year
# of Men 703 213
7-Year Death
0% 6.9%
Rate
Important Caveat: Percentage core biopsy was not
evaluated or reported in this study
33. Percent “Free” PSA
• Poor man’s substitute for measurement of
prostate size
• Percentage can range from 3% to 35%
• A high percentage (over 25%) signals BPH
• Low percentage (less than 10%) signals a small
prostate gland
• Percentages between 10% and 25% don’t
signal anything
34. Prostate Cancer Prevention Trial
Google: PCPT Risk Calculator
Thompson, JNCI 98:529, 2006
• Calculates the overall risk of prostate cancer
and the risk of high-grade prostate cancer at
biopsy
• Elements of the calculation:
– PSA, race, age, Body mass index (BMI), DRE, Prior
biopsy (yes/no), Family history, Proscar
35. Google: “PCPT Risk Calculator”
• Age 57
• BMI (are you fat?) Height 75” Weight 175’
• Race Caucasian
Risk of any type of
• PSA 4.0 prostate cancer on
• Rectal exam Normal biopsy = 35%
• Family History Negative
• Digital Rectal Normal Risk of High-Grade
prostate cancer = 6%
36. PCA-3 Urine Test
“More Accurate than Free PSA”
Haese European Urology 54:1081, 2008
• Not influenced by prostate size
• Measured after mild prostate massage
• “Normal” range is less than 35
• Used as a “cross check” for men with elevated
PSA who want to delay biopsy
37. PCA-3 of “35”
de la Taille, J. of Urol. 185:2119, 2011
• More accurate than PSA
• Higher PCA-3 levels associated with:
– Gleason 7 or greater
– 33% positive cores or greater
– High grade vs. low grade cancer
38. PCA3 Assay Sensitivity and
Specificity
at Various Cutoffs
Deras, Journal of Urology 179:1587, 2008
PCA3 % Sensitivity % Specificity
10 85 32
“Normal” 20 71 56
30 56 70
40 49 78
60 33 89
“Abnormal”
80 22 94
100 18 95
Sensitivity measures the proportion of actual positives which are correctly identified
Specificity measures the proportion of negatives which are correctly identified
39. PCPT Calculator: Example with PCA-3
• Age 57
• PCA-3 12
• BMI (are you fat?) Height 75” Weight 175’
• Race Caucasian
• PSA 4.0 Risk of any type of
• Rectal exam Normal prostate cancer: 35%
• Family History Negative with PCA-3: 29%
• Digital Rectal Normal
Unfortunately, when the PCPT calculator incorporates PCA-3
it does not provide a estimate for High-Grade disease
40. The More You Look, The More You
Find: Repeated 6-Core Biopsy in 10,000
Men Screened for PSA Over 3.0
Zackrisson, J. Urol, 171:1500, 2004
Biopsy Number Number Percentage
Biopsied Positive Positive
First 1,725 402 23%
Second 706 124 18%
Third 307 36 12%
Fourth 103 9 9%
Fifth 13 0 0%
41. Four Additional Factors Indicating a
Positive Biopsy is More Likely
1. Smaller prostate gland—under 30 cc
2. Less urinary symptoms—AUA score of 7 or less
• Porter Urology 63:90, 2004
1. Testosterone level below the normal range
– Positive biopsy
• Rhoden J. of Urol. 179:1742, 2008
– Positive surgical margins at time of surgery
• Teloken J. Urol, 174:2178, 2005
• Massengill J. Urol, 169:1670, 2003
1. Abnormality detected by imaging with
ultrasound or MRI
43. Men with Big Prostates, Rejoice
Abd, Urology 77:541, 2011
• Men with a prostate volume of 30-60 cc are
25% as likely to have prostate cancer as a man
with a prostate < 30cc
• Men with a prostate volume > 60 cc are 10%
as likely to have prostate cancer as a man with
a prostate < 30cc
44. Factors Predicting a Positive Biopsy
When PSA is Between Two and Nine
Fleshner, Urology 69:103, 2007
• Smaller prostate
• Increasing age
• Higher PSA
• Hypoechoic lesion on ultrasound
45. Color Doppler Ultrasound
• Accurately determines prostate size
• Detects hypo-echoic and hyper-vascular areas
that can be monitored with sequential scans
or targeted with biopsy
• A fifteen-minute outpatient procedure
performed in the doctor’s office
47. Imaging with 3T Multiparametric MRI
Turkbey, J. of Urol. 186:1818,2011
• Multiparametric = 4 scans in one
– T2 weighting, Diffusion, Contrast, Spectroscopy
– Accurately determines prostate size
• 3T MRI multiparametric imaging is:
– 90% accurate at detecting significant cancer
– 90% accurate at ruling out significant cancer
• 60 to 90 minute scan with rectal probe
• Abnormalities can be monitored or targeted
with biopsy
48. Theoretical Risks of Delaying a Biopsy
1. Failure to detect a high-grade prostate
cancer early enough to achieve a cure
2. Allowing high-grade disease to progress to a
more advanced stage leading to more
aggressive treatment than what would have
been necessary with earlier diagnosis
49. Some Reasons Why the Danger of a Delaying the
Diagnosis of High-Grade Disease May Be Small
• By the time cancer is diagnosed it has already
been present for many years
• Even high-grade prostate cancers can grow fairly
slowly (PSA screening every 4 years saved lives)
• Rare forms of rapidly growing high-grade disease
may be incurable anyway
• Technological progress may ultimately make
incurable cancers curable over the next 10 years
• Modern scans are pretty good at detecting
progressive high-grade cancer
50. Balance the Risk of Immediate
Biopsy with the Risk of Further Surveillance
1. Gather and evaluate information:
– PCPT Calculator: PSA, DRE, Age, Race, and Family history
– Urine PCA-3
– PSA velocity only helps if sequential PSA levels rise quickly
– Factor in:
• Urinary symptoms determined by AUA score
• Low testosterone levels
• Measurement of the prostate size
• Imaging of the gland with color doppler or MRI
1. Very carefully consider the irreversible perils of:
– The very common scenario of diagnosing low-grade disease
– The less common scenario of delaying the diagnosis of high-grade
disease
51. Valuable Information from Biopsy:
Gleason score and Percentage Cores Positive
• Challenges interpreting Gleason Score:
– It can be misread by unskilled pathologists
– Biopsy can miss high-grade disease resulting in falsely
low scores
• Percentage Cores Positive:
– The percentage of positive biopsy cores predicts
future cancer relapse and cancer progression just as
well as Gleason score
– The optimal number of cores for initial random biopsy
is eight
56. Percentage Cores Predicts Early Relapse
after Surgery in Men with PSA < 10
Aronson, J. Urol, 171:2215, 2004
Gleason Score
Cores Six or Less 3+4 4+3 or
Positive More
< 20% 8% 13% 21%
20-40% 12% 20% 31%
>40% 19% 30% 45%
57. Percentage Core Biopsy Predicts
Relapse
• Multivariate DeWolf, J. of 476 men age 61, PSA 5.8
Analysis Urol, 171:1492, 2004
– >28% cores positive = 3.6 times higher risk of relapse
– Gleason 7 = 3.9 times higher risk of relapse
– Gleason 8-10 = 12 x higher risk of relapse
58. A High Percentage of Positive Cores Predicts
Cancer Metastases in After Surgery
Roehrborn, J. Urol, 171:2209, 2004
Gleason Score % Patients in Median % of
From Biopsy Each Gleason Core Biopsies
Category Positive
4-6 66% 17%
7 28% 33%
8-10 6% 50%
59. Optimal Number of Biopsy Cores
• Random biopsy
– 8 core biopsies finds cancer as well as 12 cores
Abd, Urology 77:541, 2011
• Targeted biopsy
– Image-directed plus 6-core finds 95% of what a
random 10-core biopsy finds
Fleshner, J. Urol, 179-1321, 2008
60. Random Biopsy, Six vs. Twelve Cores
Al-Ghamdi J. Urol. 179:1332, 2008
• 679 men with median PSA 5.3 and age 62
• With 6 cores: 179 cancers found (26% men)
• With 12 cores: 240 cancers found (35% men)
Gleason Six Twelve Number Percent
Grade Core Core Increased Increase
Total 179 240 61 9%
Six or less 146 193 47 7%
7 or more 33 47 14 2%
61. Recommendations for PSA Screening
• Start PSA testing at age 40 to establish a
personal “normal level” rather than comparing
to the general population i.e., PSA > 2.5 or >4
• To optimize PSA testing:
– Abstain from sexual activity for 48 hours
– Ensure no urinary symptoms of prostate infection
– For ongoing testing, use same lab for consistency
• Men with low levels of 1 or less can get PSA
checks every 3-4 years in their 40’s
62. What Should Trigger a Biopsy?
• Persistently elevated PSA with a small prostate
(<30cc) without another reason for PSA rise
• An abnormal DRE that can’t be attributed to a benign
etiology (such as calcification) after scanning with
ultrasound
• An elevated PCA-3 level
• An abnormality seen with color Doppler or MRI
suggestive of underlying high-grade cancer
• An informed patient who is more concerned about
missing high-grade disease than dealing with the
consequences of being diagnosed with a low-grade
prostate cancer
63. Conclusions
• PSA screening saves lives
• Overtreatment is inevitable when mindless
biopsies are performed on an uninformed
populace
• An elevated PSA should trigger both education
and further testing with PCA-3 and prostate
imaging
• While not perfect, biopsy core percentage and
biopsy Gleason both yield very powerful
information about cancer status