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.
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
Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing
Objective: To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis.
Conclusion: Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing
Objective: To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis.
Conclusion: Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Principles of Screening
Disease should have a high incidence
Biological behavior and natural history of the disease should be known
Test should have high sensitivity, specificity, and positive predictive
value
value
Test should be rapid, inexpensive, noninvasive, and acceptable to
patients
Acceptable and efficacious method of treatment must exist for patients
diagnosed with disease
Screening should lower the disease-specific morbidity and increase
survival ?
3. Prostate Cancer
Lifetime risk of being diagnosed with prostate cancer is
15.3% but risk of dying of prostate cancer is only 2.6%
Presentation
Early stages usually asymptomatic
Most cases detected by serum PSA or abnormal DRE
Campell-walsh 11th Ed
5. Screening and early detection
Population or mass screening is defined as the ‘systematic
examination of asymptomatic men (at risk)’ and is usually
initiated by health authorities. In contrast, early detection or
opportunistic testing consists of individual case findings,
which are initiated by the man being tested (patient) and/or
opportunistic testing consists of individual case findings,
which are initiated by the man being tested (patient) and/or
his physician.
The co-primary objectives of both strategies are:
reduction in mortality due to PCa;
at least, a maintained quality of life (QoL) as expressed by QoL-
adjusted gain in life years
6. Prostate Cancer screening
Most effective method for detection is combined use
of Prostate Specific Antigen (PSA) and Digital Rectal
Exam (DRE)
~15% of men with cancer have PSA <4
PSA and DRE are complementary because they do not
always detect the same cancers
7. Major Risk Factors
Age
Incidence rises rapidly after age 50
Over 60% of new cases diagnosed in men over 65
Family history
Family history
1st degree relative with cancer more than doubles risk
Brother > father
Multiple relatives > single relative
Multiple generations at early age > single generation at older age
Race
African-American men are more than twice as likely to die from prostate cancer than
Caucasian men
8. PSA facts
Discovered in 1970
Most widely used oncologic biomarker
¾ men over 50 have had a PSA
Member of the human kallikrein family of
glycoproteins
Produced by the glandular epithelium of the prostate
Trace amounts in salivary, pancreatic and breast
tissue
9. PSA facts
Found in semen, urine and blood
Serine protease that liquefies semen to improve
sperm mobility
sperm mobility
Found in 3 forms in serum:
Bound to α-1-antichymotrypsin
Bound to α-2-macroglobulin
Free PSA
10. PSA Challenges …..
No clear cut-point between normal and abnormal PSA . Even PSA cut-off
of 2.0ng/ml miss some prostate cancers. (The Cancer Prevention Trial - 2003)
Positive predictive value for PSA > 4 ng/ml = 30% (about 1 in 3 men with
Positive predictive value for PSA > 4 ng/ml = 30%
elevated PSA have prostate cancer detected at time of biopsy)
PPV increases to 45-60% for PSA > 10 ng/ml
Nearly 75% of cancers detected in the grey zone (PSA 4-10) are organ
confined; potentially curable.
<50% of prostate cancers organ confined if PSA >10
11. PSA is NOT Perfect
Poor sensitivity (35–70%), specificity (60–90%) for prostate
cancer
Sensitivity of biopsy in the screened is 60-80% at best
The traditional PSA cut-off of 4.0 is no longer an absolute
The traditional PSA cut-off of 4.0 is no longer an absolute
indication for biopsy
Other factors that affect PSA:
Infection/Inflammation/Instrumentation
Urinary retention
Ejaculation/Vigorous massage
Advanced age/Benign enlargement
12. Improving Specificity of PSA
Repeat PSA before reacting
PSA Density
≥ 0.15 ng/mL/cm3 associated with CaP
PSA velocity
PSA velocity
A rate of change > 0.75 ng/mL/yr (4 < PSA < 10)
A rate of change > 0.35 ng/ml/yr (PSA < 2.5)
Rates > 2 ng/mL/year have been associated with a quicker time to death from recurrent
disease
13. Improving Specificity of PSA
Percent free PSA: 25% cutoff: 95% sensitivity & eliminates 20% of unnecessary
biopsies
< 15% Suspicious for cancer
> 24% Suggests benign disease
> 24% Suggests benign disease
15-24% Grey area
Age-Specific Thresholds : Age-adjusted PSA
40 to 49 - 0.0 to 2.5
50 to 59 - 0.0 to 3.5
60 to 69 - 0.0 to 4.5
70 to 79 years - 0.0 to 6.5
14. PLCO (Prostate, Lung, Colorectal, Ovarian) Cancer Screening Trial
US trial 76,693 men randomly assigned to annual screen with PSA & DRE or to
“usual care”; median follow-up of 11yrs
No difference in prostate-specific mortality between the 2 groups
Prostate Cancer Screening
the evidence …..
No difference in prostate-specific mortality between the 2 groups
Screening and Prostate Cancer Mortality in a European RCT (ERSPC)
162,243 men from 7 countries randomized to screening with PSA (q 4yrs) or no
screening; median follow-up of 9yrs
20% reduction in prostate cancer mortality in the screening arm (p=0.04)
Goteborg Prostate-Cancer Screening Trial
20,000 men age 50-69; PSA screen(q 2yrs) or no screen, (1995>2008)
44% reduction in prostate cancer specific mortality (p=0.002)
15. ERSPC: “The European study”
Random assignment of men between 50 and
74 in 7 European countries
83,000 in the screened group; 99,000 in the control
83,000 in the screened group; 99,000 in the control
PSA on average once every 4 years in screened cohort
During the median follow up of 11 years, PCa
diagnosed in 9.6% of the screened group and
6.0% of controls
Schröder FH, NEJM 2012
16. ERSPC findings 2012
• Screened group was 29% less likely to die from CAP
• 1055 men would need to be screened and 37 cases of
prostate cancer treated to prevent 1 death
17. Issues with this Study
Positive PSA defined as 3.0 ng/ml in most centers
6-core biopsy used: prostate cancer diagnosis is up
to 20% higher with an extended biopsy scheme (10-
to 20% higher with an extended biopsy scheme (10-
18 cores)
Localized prostate cancer more common in the
screened group
A definite benefit of avoiding metastatic disease
18. Goteborg Study
F/U 14 years, decrease risk of death 40%
227 screened, 12 dx to prevent 1 death
19. PLCO: “The US trial”
38,000 men each randomly assigned to annual
screening or “usual care”
Compliance rates for PSA and DRE were 85% and 86%,
respectively
respectively
Usual care included up to 52% getting annual PSA and 46%
getting yearly DRE
Follow up was for 7 to 10 years
Andriole GL, NEJM 2009; 360:1310-1319
20. PLCO results 2009
116 vs. 95 incident cases per 10,000 PY in S vs. C
2.0 vs. 1.7 deaths per 10,000 PY in S vs. C
21. Issues with this Study
High rate of screening in the control group – diluted
results
Follow up of 7 to 10 years not long enough to
Follow up of 7 to 10 years not long enough to
realize a mortality advantage from screening
Using an absolute value of 4.0 ng/ml as a “positive”
PSA may lead to under-diagnosis
18% fewer Gleason 8-10 prostate cancers in the
screening group
22. US Preventive Services Task Force
‘USPSTF’ Considerations
Reason for USPSTF investigation: Likely over-diagnosis and over-treatment
of prostate cancer.
In 2012 the USPSTF recommended against PSA screening on the grounds
that there is no net benefit and that the potential harms outweigh the
that there is no net benefit and that the potential harms outweigh the
benefits. Grade D
The harms identified by USPSTF are overestimated and relate more to
treatment than screening.
Not all prostate cancers require treatment. The patient is entitled to know
whether he has prostate cancer and be allowed to decide if he desires
treatment. A recommendation against screening deprives him of that
autonomy.
23. Impact of the United States Preventive Services Task Force 'D'
recommendation on prostate cancer screening and staging
Recent findings: Following the USPSTF recommendation, a substantial
decline in PSA screening was noted for all age groups. Similarly, overall
rates of prostate biopsy and prostate cancer incidence have significantly
decreased with a shift toward higher grade and stage disease upon
decreased with a shift toward higher grade and stage disease upon
diagnosis.
Concurrently, the incidence of metastatic prostate cancer has significantly
risen in the United States. These trends are concerning particularly for
the younger men with occult high-grade disease who are expected to
benefit the most from early detection and definitive prostate cancer
treatment.
24. 2017 USPSTF Screening Update
The decision about whether to be screened for prostate cancer should be an individual one.
The USPSTF recommends that clinicians inform men ages 55 to 69 years about the potential
benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer.
Screening offers a small potential benefit of reducing the chance of dying of prostate cancer.
However, many men will experience potential harms of screening, including false-positive
However, many men will experience potential harms of screening, including false-positive
results that require additional workup, over-diagnosis and overtreatment, and
treatment complications such as incontinence and impotence.
The USPSTF recommends individualized decision-making about screening for prostate
cancer after discussion with a clinician, so that each man has an opportunity to understand
the potential benefits and harms of screening and to incorporate his values and preferences
into his decision.
Recommendation Grade C (Offer or provide this service for selected patients depending on
individual circumstances)
25. 2017 USPSTF Screening Update
Men age 70 and older
The USPSTF recommends against PSA-based screening for
prostate cancer in men age 70 years and older.
prostate cancer in men age 70 years and older.
Recommendation Grade D (Discourage the use of this
service)
26.
27. Screening for Prostate Cancer:
CTF Recommendations
27
For men aged less than 55 years, we recommend not
screening for prostate cancer with the prostate-specific
antigen test. (Strong; low quality evidence)
For men aged 55–69 years, we recommend not screening
For men aged 55–69 years, we recommend not screening
for prostate cancer with the prostate-specific antigen test.
(Weak; moderate quality evidence)
For men 70 years of age and older, we recommend not
screening for prostate cancer with the prostate-specific
antigen test. (Strong; low quality evidence)
Canadian Task Force, 2014
28. EAU 2018
Cochrane review published in 2013 , which has been updated since presents the main
overview of the date. The findings of the updated publication (based on a literature search
until April 3, 2013) are almost identical to the 2009 review:
Screening is associated with an increased diagnosis of PCa (RR: 1.3; 95% CI: 1.02-1.65).
Screening is associated with detection of more localised disease (RR: 1.79; 95% CI: 1.19-2.70) and
less advanced PCa (T3-4, N1, M1) (RR: 0.80; 95% CI: 0.73-0.87).
less advanced PCa (T3-4, N1, M1) (RR: 0.80; 95% CI: 0.73-0.87).
From the results of five RCTs, randomising more than 341,000 men, no PCa-specific survival benefit
was observed (RR: 1.00; 95% CI: 0.86-1.17). This was the main endpoint in all trials.
From the results of four available RCTs, no overall survival (OS) benefit was observed (RR: 1.00;
95% CI: 0.96-1.03).
Moreover, screening was associated with minor and major harms such as over-diagnosis and
over-treatment.
Surprisingly, the diagnostic tool (i.e. biopsy) was not associated with any mortality in the
selected papers
29. The reduced mortality rate seen recently in the USA is
considered to be partly due to a widely adopted
aggressive PCa screening policy. However, there is still
aggressive PCa screening policy. However, there is still
no level 1 evidence that PSA mass screening is cost-
effective in reducing PCa mortality
Currently, screening for PCa is one of the most
controversial topics in the urological literature
30. GR
LE
2018 EUA Recommendations for screening and early Detection
B
3
Do not subject men to prostate-specific antigen (PSA) testing without counseling them on the
potential risks and benefits.
B
3
Offer an individualized risk-adapted strategy for early detection to a well-informed man with a
good performance status and a life-expectancy of at least ten to fifteen years.
A
2b
Offer early PSA testing in well-informed men at elevated risk of having PCa:
• men > 50 years of age;
• men > 45 years of age and a family history of PCa;
• African-Americans > 45 years of age;
• African-Americans > 45 years of age;
• men with a PSA level of > 1 ng/mL at 40 years of age;
• men with a PSA level of > 2 ng/mL at 60 years of age.
C
3
Offer a risk-adapted strategy (based on initial PSA level), with follow-up intervals of two years
for those initially at risk:
• men with a PSA level of > 1 ng/mL at 40 years of age;
• men with a PSA level of > 2 ng/mL at 60 years of age;
Postpone follow-up to eight years in those not at risk.
C
3
Decide on the age at which early diagnosis of PCa should be stopped based on life expectancy
and performance status; men who have a life-expectancy of < 15-years are unlikely to benefit.
32. Developed an algorithm to
combine serum PSA and
urine TMPRSS2:ERG fusion
urine TMPRSS2:ERG fusion
and PCA3 to predict prostate
cancer on subsequent biopsy
Improved cancer prediction
(AUC=0.88; specificity 90%;
sensitivity 80%)
34. Multi-parametric Prostate MRI
Technique and sequences are crucial – 3 phases obtained
1. T2: peripheral zone exhibits high signal intensity
• Peripheral zone cancers have low T2 signal intensity – the lower the intensity the higher grade the
disease
• Cancer more difficult to discern in the transition zone due to signal heterogeneity in this region
2. Diffusion weighted MR measures random motion of water molecules – DWI can help
identify high-risk disease
3. Dynamic contrast enhanced (gadolinium) MR allows evaluation of contrast kinetics –
cancer enhances quickly, more intensely and with a faster washout
MP-MRI sensitivity is 80% for detecting 0.2cm3 disease ≥ Gleason 4+3 or 0.5cm3 Gleason
3+4.
35. 170 patients with negative biopsy but persistent suspicion of prostate
cancer
Blinded standard systematic prostate biopsy performed
Blinded standard systematic prostate biopsy performed
Receiver Operating Characteristic (ROC) analysis showed that MP-
MRI contributed most to the prediction model (AUC 0.936)
MP-MRI only significant independent predictor of prostate cancer
diagnosis
Can a MP-MRI without lesion negate the need for repeat prostate
biopsy?
37. Prostate Biopsy
> 1.2 million prostate biopsies are performed yearly
in the US
Elevated PSA most frequently triggers biopsy
Elevated PSA most frequently triggers biopsy
30% of men referred for biopsy are diagnosed with
prostate cancer
Relies on random sampling
38. Shortcomings of Standard Systematic Prostate
Biopsy
False-negative rate
Incorrect risk stratification (up to 45%)
Detection of clinically insignificant disease
Need for repeat biopsy
Need for repeat biopsy
Disease overtreatment
Increasing the core number (saturation or repeat biopsy) does not significantly
reduce the risk of under sampling and incorrect risk stratification
More biopsy episodes increases the risk of detecting indolent cancers
Goal: Detect high-grade disease while avoiding low risk disease
39.
40. Patients with low,
intermediate and high
suspicion lesions had
cancer diagnosed 28%,
67% and 90% of the time
Fusion biopsy detected
more cancer per core than
12-core biopsy
41. 195 men with previous negative biopsy with targets on
MP-MRI underwent MR/US fusion and 12-core biopsy
37% were found to have cancer
11% had high-grade (Gleason 8+) – 55% of these were
missed with standard biopsy
39% were upgraded on fusion biopsy vs standard biopsy
42.
43.
44. HomeMessage
Offer PCa screening on individual basis according to risks.
Not all prostate cancers require treatment. The patient is entitled to know whether
he has prostate cancer and be allowed to decide if he desires treatment
Prostate cancer screening is worthwhile, as evidenced by negative repercussions of
Prostate cancer screening is worthwhile, as evidenced by negative repercussions of
the USPSTF recommendations
Prostate cancer screening should include PSA and DRE.
Obtain a confirmatory test prior to proceeding with biopsy to help refine risk
Serious prostate biopsy complications are very rare and should not discourage
screening.
Obtain MRI to help improve the yield of biopsy
Promote active surveillance as front line treatment in appropriate patients