Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
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.
Vasectomy and Risk of Aggressive Prostate CancerDrLukeKane
Presentation and critique of July 2014 paper on whether there is a link between vasectomy and prostate cancer.
Presented to urology departmental meeting in London teaching hospital
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
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
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.
Vasectomy and Risk of Aggressive Prostate CancerDrLukeKane
Presentation and critique of July 2014 paper on whether there is a link between vasectomy and prostate cancer.
Presented to urology departmental meeting in London teaching hospital
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
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Assessment of Incidence and Prevalence of Prostate Cancer in Middle Aged Male...BRNSS Publication Hub
This study was conducted to evaluate the incidence of prostate cancer (PCa) in male patients with increased prostate-specific antigen (PSA), and normal or abnormal digital rectal examination (DRE) that underwent a prostate biopsy. From March 2018 to November 2018, a total of 98 consecutive males suspected of having PCa due to increased PSA levels underwent transrectal ultrasonography (TRUS)-guided sextant biopsy of the prostate. The total PSA (tPSA), demographic data, the incidence of PCa, benign prostate hyperplasia (BPH), and prostatitis were assessed. The patients were divided into two groups according to their PSA values (Group A serum tPSA level, 4–10 ng/mL; and Group B serum tPSA level, 10.1–20.0 ng/mL). Of the 98 biopsied cases, 56% had PCa, 23% had BPH, and 21% had prostatitis. The mean PSA and the age of the carcinoma group were significantly higher than those of the benign group (P < 0.01). The biopsy results were grouped as PCa, BPH, and prostatitis. The incidence of PCa for Group A and Group B cases was 51% and 65%, respectively. In the case of PCa, BPH, and prostatitis, the mean PSAs were 10.02 ng/mL, 8.76 ng/mL, and 8.41 ng/mL, respectively (P < 0.40). In conclusion, TRUS-guided prostate biopsy and interpretation by a skilled team are highly recommended for early detection of PCa or its ruling-out. Due to the very high incidence of PCa in the patients with PSA >10 ng/mL, TRUS-guided biopsy is indicated, whatever the findings on DRE and/or LUTS, since the PCa detection rate is high.
Role of Prostate Health Index in the changing landscape of prostate cancer di...Lincoln Tan
The prostate health index is superior to PSA and %fPSA, and can be integrated with MRI in predicting who needs prostate biopsies, and sparing men from unnecessary biopsies.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
MANAGEMENT OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY & RADIATION ...
tom2
1. RESULTS: The potential reduction in unnecessary biopsies for
the entire population using this approach was 80% based on deceler-
ation and 72% based on decrease below the level prior to biopsy. The
reduction varied substantially among the groups of exponential growth
rates in PSA. For example, reductions for decrease started at 59% for
very slow exponential PSA growth rates of 0%-5% and reached 93% for
fast PSA growth greater than 100% per year.
CONCLUSIONS: This analysis suggests that a delay in a bi-
opsy to allow additional PSA testing provides useful information about
PSA trends. In many cases, subsequent PSA trends showed a sub-
stantial deceleration or decrease that could have reduced the number of
unnecessary biopsies by 72-80%. The fastest growth in PSA per year
was also the most likely to decrease, with potential reductions of 93%
in biopsies.
Source of Funding: NONE
MP63-04
NEW ANALYSIS OF PSA TRENDS HELPS IDENTIFY DEADLY
CANCERS PRIOR TO BIOPSY
Lori Rawson*, Roy MacKintosh, Reno, NV; Christopher Morrell,
Baltimore, MD; R. Jeffrey Karnes, Rochester, MN; Stacy Loeb,
New York, NY; Stephen Van Den Eeden, Oakland, CA; Thomas Neville,
Incline Village, NV
INTRODUCTION AND OBJECTIVES: A major prostate cancer
screening challenge is to balance the potential harm of biopsies and
over-treatment with the need to identify deadly cancers early for
effective treatment. Observation of men with deadly cancer and their
prior PSA levels often appears to show exponential growth in PSA
over and above baseline PSA of a benign nature. Preliminary
research on small populations has suggested that faster exponential
growth rates in PSA above a no-cancer baseline are indicative of
more deadly cancers. Our objective was to validate the relationship
between dynamic PSA trends and later prostate cancer mortality on a
large population.
METHODS: We analyzed Veterans Affairs data on 58,523 men
age 50-75 (median 66) who had been diagnosed with prostate cancer
between 2001-2012 with at least three PSA tests over at least two years
prior to diagnosis. We fit an exponential plus constant trend to the PSA
tests for each man. This process allowed us to estimate for each man
the amount of PSA that might be coming from cancer and its annual
exponential growth rate. Men were grouped by ranges of age, cancer
PSA and growth rates. For each group, we utilized Kaplan Meier
methods to estimate all-cause death risk for years after diagnosis.
Cancer-specific death was estimated for each group using net-survival
methods based on an estimate of cancer-free survival and were
compared by the log rank test.
RESULTS: For a given PSA range, the faster the growth in PSA
measured in this way, the more deadly the cancer. For every range of
cancer PSA, all-cause and cancer-specific death increased substan-
tially for faster PSA growth (p<0.0001). For example, Figure 1 shows
the robust relationship between dynamic PSA trends with later prostate
cancer death in >30,000 men ages 50 to 75. These results held up for
various age ranges and types of treatment.
CONCLUSIONS: Higher annual exponential growth rates in
cancer PSA were significantly associated with all-cause and cancer-
specific death in our large population-based cohort. For men with a PSA
history, the growth rate calculated using these methods is highly
indicative of which men harbor life-threatening prostate cancer. This
result may help address the challenge issued by the U.S. Preventive
Services Task Force to develop screening methods to distinguish
potentially deadly cancers from non-progressive or slowly progres-
sive disease.
Source of Funding: NONE
MP63-05
SERUM TESTOSTERONE IMPROVES THE ACCURACY OF
PROSTATE HEALTH INDEX FOR THE DETECTION OF PROSTATE
CANCER
Frank Friedersdorff*, Kurt Miller, Klaus Jung, Carsten Stephan, Berlin,
Germany
INTRODUCTION AND OBJECTIVES: The detection of pros-
tate cancer (PCa) hampers on low specificity when using prostate-
specific antigen (PSA) alone. This study investigated the effects of total
testosterone (tT) and its free (fT) and bioavailable (bioT) subforms in
serum to improve the diagnostic validity of serum (-2)pro-PSA-based
prostate health index (PHI).
METHODS: Total and free PSA (tPSA, fPSA), (-2)pro-PSA,
testosterone, and sex-hormone-binding protein were measured by
automated immunoassays from the serum of 193 men scheduled for
prostate biopsy (99 with PCa and 94 with no evidence of malignancy).
FT and bioT were calculated using an online calculator. Statistical an-
alyses were performed by non-parametric tests (Wilcoxon signed rank,
Mann-Whitney, Kruskal-Wallis), binary logistic regression, and receiver
operating characteristics (ROC) analyses.
RESULTS: Compared to the non-malignant controls, PCa pa-
tients had significantly higher levels of tPSA and PHI, but lower levels of
%fPSA, tT, fT, and bioT. PCa could be differentiated from controls by
PHI, tT, fT, bioT, and %fPSA. PHI showed the largest area under the
ROC curve (AUC ¼ 0.73) that was additionally increased by the in-
clusion of bioT or tT in a binary logistic regression model. The AUC of
PHI in patients with tT concentrations of <8 nmol/L indicating
biochemical hypogonadism was significantly larger than that in patients
with higher tT values (0.86 vs 0.70).
CONCLUSIONS: The PHI based discrimination between PCa
patients and non-malignant controls could be improved by the simul-
taneous determination of testosterone, while patients with testosterone
concentration of <8 nmol/L have the greatest advantage.
Source of Funding: none
e710 THE JOURNAL OF UROLOGYâ Vol. 191, No. 4S, Supplement, Monday, May 19, 2014