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.
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.
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.
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.
The prostate is the gland below a man's bladder
that produces fluid for semen. Prostate cancer is common among older men. It is
rare in men younger than 40. Risk factors for developing prostate cancer
include being over 65 years of age, family history, being African-American, and
some genetic changes.
Symptoms of prostate cancer may include:
-- Problems passing urine, such as pain,
difficulty starting or stopping the stream, or dribbling
-- Low back pain
-- Pain with ejaculation
Your doctor will diagnose prostate cancer
by feeling the prostate through the wall of the rectum or doing a blood test
for prostate-specific antigen (PSA). Other tests include ultrasound, x-rays, or
a biopsy.
Treatment often depends on the stage of the
cancer. How fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Men with prostate cancer have many treatment
options. The treatment that's best for one man may not be best for another. The
options include watchful waiting, surgery, radiation therapy, hormone therapy,
and chemotherapy. You may have a combination of treatments.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
The prostate is the gland below a man's bladder
that produces fluid for semen. Prostate cancer is common among older men. It is
rare in men younger than 40. Risk factors for developing prostate cancer
include being over 65 years of age, family history, being African-American, and
some genetic changes.
Symptoms of prostate cancer may include:
-- Problems passing urine, such as pain,
difficulty starting or stopping the stream, or dribbling
-- Low back pain
-- Pain with ejaculation
Your doctor will diagnose prostate cancer
by feeling the prostate through the wall of the rectum or doing a blood test
for prostate-specific antigen (PSA). Other tests include ultrasound, x-rays, or
a biopsy.
Treatment often depends on the stage of the
cancer. How fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Men with prostate cancer have many treatment
options. The treatment that's best for one man may not be best for another. The
options include watchful waiting, surgery, radiation therapy, hormone therapy,
and chemotherapy. You may have a combination of treatments.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Care for the Caregiver : 12 Tips for Overcoming LossBrightStar Care
Dealing with grief is essential in order to come to terms with the loss of a loved one and move forward. While each caregiver deals with loss in his or her own way, there is help on the horizon.
Link to article - http://heartsense.in/what-enlarged-prostate-gland/
Dr Vivek Baliga discusses why the prostate gland enlarges, what it means and how it can be managed. Patient presentation.
For academic articles, visit http://drvivekbaliga.net
An overview of the theories and practice principles relating to loss and bereavement. Content has kindly been provided by Barbara Beard, senior lecturer at Sheffield Hallam University, specialising in supportive and palliative care.
Week 6 DiscussionQuestion ARisk management is a matter of id.docxcockekeshia
Week 6 Discussion
Question A
Risk management is a matter of identifying the situations that could cause your project to fail. Common risks include loss of staff, decreased funding, decision point approvals not completed in a timely manner, and content not being available. Brainstorm three or four other risks that you have seen in your professional experience. If you are having trouble identifying projects, brainstorm with your classmates or contact your instructor.Once you have 3-4 risks, identify at least two ways to prevent each and two ways to resolve them, if they happen in spite of your preventions. Post your ideas.
Question B
How does the Work Breakdown Structure (WBS) help to minimize risks? How often should a risk analysis be conducted? Why are risks often overlooked?
1-Today I am going to talk to you about prostate cancer. The purpose of my presentation is to discuss the role of diagnostic imaging in prostate cancer patient. I will start my presentation by introducing the condition of the pathology, then I will mention the general symptoms, investigation staging and treatment of the condition. Then I will focus on the patient case study pathway. Finally, I will summarise my presentation and I will give you time for questions after the presentation.
2- Prostate cancer is a fatal disease that affects millions of men worldwide every year. Its clinical behavior ranges from low grade tumours that never develop to aggressive tumours those growths into metastases disease (Johnson et al, 2014). The cause of the disease has not been found, but several related risk factors have been known, such as genetics, age and diet. Prostate cancer is the highest prevalent non-skin malignant tumors diagnosis in male patients in the UK, accounting 24% of entirely new cancers. The main prospect of developing prostate cancer is related to advancing age, that has been seen diagnoses occurring in men over the age of 65 and is rare in those 40 years of age (Stephens et al, 2008)
3- prostate gland is a walnut' sized structure which located between the penis and the bladder and surrounds the urethra, just lies posteriorly to rectum. It has functional relation with urinary and reproductive systems and its main role is to produce the liquid part of semen. Prostate gland divided into three distinctive anatomic zonal components: the central zone, transitional zone and the peripheral zone which compromises 70% by volume (Tempany & Franco, 2012).
4- The preponderance of prostate cancers is adenocarcinomas that initially derived from the outer or peripheral zone of the prostate gland. In early stage, prostate cancer hardly shows symptoms and is mostly diagnosed by fortunate PSA test, but overtime patient may present to clinic with lower urinary tract symptoms such as: trouble starting urine, pain during urination, increased urgent of urination, poor stream, erection trouble so on (Wijesinha & Fridenberg, 2007)
5- The initial tests for diagnosing prostate cancer a.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
EAU - Guidelines on Prostate Cancer Organ Confined by Dr. Ali Mujtaba, Sindh Institute of Urology and Transplantation (SIUT)
https://www.youtube.com/watch?v=kXX9ItF4as4
https://www.youtube.com/watch?v=0m4YUI6Rr5w
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- 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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Prostate Cancer Testing and Screening
1. Part of the “Enhancing Prostate Cancer Care” MOOC
Catherine Holborn
Senior Lecturer in Radiotherapy & Oncology
Sheffield Hallam University
2. Introduction
Debate and discussion regarding testing and screening
for prostate cancer, focuses on men who are without any
symptoms (asymptomatic)
Men with early prostate cancer very often do not have
any symptoms
So a test is arguably needed to detect prostate cancer at
an early stage, whilst it is still very treatable
In turn, this should reduce mortality rates, whilst also
maintaining quality of life
This presentation provides an insight into the complexity
of this topic, and the research undertaken
3. The PSA test
The current available test
Not a test for prostate cancer, just prostate cancer risk
Further, more invasive tests may be needed
False positives and false negatives are possible with the
PSA test
Nevertheless….It can lead to the diagnosis of a prostate
cancer that requires treatment, and is still treatable
For many men who did not receive a diagnosis of
prostate cancer until they had developed symptoms, and
often more advanced disease, the benefit of PSA testing
in asymptomatic men, is in no doubt!
4. Population vs. Opportunistic
Population based screening
All asymptomatic men, within a given age range would
be invited to have the PSA blood test
Opportunistic testing
Initiated by the man and/or their doctor, based on an
individual case findings and an assessment of risk vs. the
benefits of testing
5. Benefits, risks, implications…
The PSA test is responsible for significant increases in the incidence and
detection of early stage prostate cancers
Reductions in mortality rates have been observed in some population based
screening trials
However, they have also demonstrated the significant problem of over-diagnosis
and over-treatment
Men are diagnosed with an early stage cancer, very early in it’s
development and if it is slow growing it may take up to 10-12yrs to become
clinically significant
In a mans lifetime they may never cause any significant problems
As a result, men may arguably receive unnecessary treatment and be
subjected to the side effects associated with this
Unfortunately, there is currently no test that can definitively tell us whether
a very early prostate cancer is indolent/slow growing or more aggressive
6. PLCO cancer screening trial¹
Prostate, Lung, Colorectal and Ovarian screening
Recruited 76,693 men.
After 7 years follow up, no significant difference in
reduced mortality between the control and screening
groups.
Histology and Gleason grade did not differ significantly
between the two groups. The majority of cases were
stage 2.
There was ‘contamination’ in the control group though.
This might help to explain the lack of difference.
7. ERSPC trial¹ ² ³
European Randomised Study of Screening for Prostate
Cancer.
Recruited 182,000 men.
A reduction in mortality was observed in the screening
group (214 deaths compared to 326 in the control).
Screening most beneficial in the 55-69yrs age group.
Accounting for non-attendance and contamination it was
calculated that screening would reduce risk of dying from
prostate cancer by up to 31%
Similar analysis of just the Rotterdam section, calculated
this as up to 51%
8. However…
Over-diagnosis and over-treatment was evident
ERSPC also calculated that to prevent 1 death from
prostate cancer 1410 men would need to be screened
(1068 adjusting for non-compliance) and 48 men would
need to be treated ¹ ²
9. Potential impact of over-diagnosis
A man is healthy and without symptoms
He has a PSA test that leads to the diagnosis of an early
prostate cancer, that may not cause any problems in his
lifetime
He knows he has a prostate cancer but will now be most
likely advised to embark on an active surveillance
programme (close monitoring for signs of progression, NOT definitive
treatment)
He may choose to have definitive treatment with surgery
or radiotherapy but this will affect his urinary and sexual
function (and possibly bowel function), when arguably
treatment was not needed
10. Other relevant findings
High rate of false positives in ERSPC trial
3 out of 4 men (75%)with an elevated PSA were not
found to have cancer
Significant increases in distress at the time of biopsy
compared with levels of distress associated with the PSA
test have been found (analysis of data from the UK ProtecT trial; 195 men
who had received a negative biopsy) ⁴
Distress levels remained immediately after the negative
biopsy result and also 12 weeks later ⁴
11. Informing asymptomatic men
The PSA test can lead to the diagnosis of a cancer that requires immediate
treatment, but may still be treatable, or at least can be controlled
PSA only enables assessment of risk, alongside the DRE and other risk
factors
Other tests are needed
The TRUS guided biopsy has associated risks/complications
Research has shown 75% of men will not be found to have cancer upon
biopsy
False negatives are also possible with the biopsy. Further testing and long
term monitoring may be required if PSA levels remain elevated
For a very early stage cancer, the advice may be NOT to treat; BUT you will
be closely monitored for signs of progression/need for treatment
If you are treated then this may affect your urinary and sexual function
(possibly bowel)
12. Opportunistic testing
Approach adopted by UK and many other countries
Tendency to promote the opportunity to be tested after
a certain age BUT….
Stress that this should include information about the
benefits and risks, enabling men to make an informed
decision
Questions still remain though and variations exist
What age to start providing the opportunity to be PSA tested?
How frequently to test?
What age to not test/stop testing?
Should targeted screening programmes be adopted for men with high
risk features e.g. Black men or those with familial links?
13. The Melbourne Consensus Statement⁵
1. For men aged 50-69 years, evidence shows that PSA testing reduces the
incidence of metastatic prostate cancer and prostate cancer specific
mortality rates
2. Prostate cancer diagnosis must be uncoupled from prostate cancer
intervention (treatment)
3. PSA testing should not be considered on its own but as part of a multi-variable
approach to early prostate cancer detection
4. Baseline PSA testing for men in their 40’s is useful for predicting the
future risk of prostate cancer and its aggressive forms
5. Older men in good health with a life expectancy of >10 years should not
be denied PSA testing based on their age
14. Focus of current research
Finding a better test for prostate cancer or at least the
risk of prostate cancer
Tumour markers e.g. PCA3 urine test
Imaging methods e.g. multi-parametric MRI
Learning about the genetics of prostate cancer
Which genes predispose a man to developing prostate
cancer?
Are there specific characteristics that help to distinguish
between indolent and aggressive cancers?
15. Suggested activity
A number of organisations have provided stances on the use
of PSA testing for prostate cancer. For example:
United Kingdom (PCRMP)
US Preventative Services Task Force
American Urological Association
American Cancer Society
Cancer Council Australia / Australian Health Ministers Advisory Council
Urological Society of Australia and New Zealand
You may want to find out more about what position they take
and the detail in their advice e.g. age when PSA testing could
start.
What is the position in your country? How well is this
publicised?
16. References
1. Eckersberger E, Finkelstein J, Sadri H, Margreiter M, Taneja SS, Lepor H, Djavan B.
Screening for Prostate Cancer: A Review of the ERSPC and PLCO trials. Review in
Urology. 2009. 11(3) pp. 127-133
2. Roobol MJ, Kerkhof M, Schroder FH, Sasieni P, Hakama M, Stenman UH et al. Prostate
Cancer Mortality Reduction by Prostate-Specific Antigen-Based Screening Adjusted for
Nonattendance and Contamination in the European Randomised Study of Screening
for Prostate Cancer (ERSPC). European Urology. 2009. 56 pp. 584-591
3. Bokhurst LP, Bangma CH, van Leenders GJLH, Lous JL, Moss SM, Schroder FH, Roobol
MJ. Prostate-Specific Antigen-Based Prostate Cancer Screening: Reduction of Prostate
Cancer Mortality after Correction for Nonattendance and Contamination in the
Rotterdam Section of the European Randomised Study of Screening for Prostate
Cancer. European Urology. 2014. 65 pp. 329-336
4. Macefield RC, Metcalfe C, Lane JA, Donovan JL, Avery KN, Blazeby JM et al. Impact of
prostate cancer testing: an evaluation of the emotional consequences of a negative
biospy results. British Journal of Cancer. 2010. 102. pp. 1335-1340
5. Murphy DG, Ahlering T, Catalona WJ, Crowe H, Crowe J, Clarke N et al. The Melbourne
Consensus Statement on the Early Detection of Prostate Cancer. BJU International.
2014. 113(2) pp. 186-188