Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Nicolas Mottet: How to organize PSA screening

551 views

Published on

European Prostate Cancer Awareness Day 2019

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Nicolas Mottet: How to organize PSA screening

  1. 1. How to organize / re-introduce PSA screening N. Mottet Urology department St Etienne Chairman EAU-ESTRO-ESUR-SIOG prostate cancer guidelines
  2. 2. Disclosure None with the topic
  3. 3. SCREENING ? Unchanged in 2019
  4. 4. AT RISK ? Genetic testing (such as BRCA) considered too preliminary to be included Population at risk Unchanged in 2019
  5. 5. EARLY PSA IN GUIDELINES Very early PSA suggested Early PSA (40-45 yrs of age) predicts PCa mortality / advanced disease at diagnosis Vickers BMJ 2013, Carlsson BMJ 2014, Preston J Clin Oncol 2016 THEN decreases follow up pressure if not at risk Unchanged in 2019
  6. 6. AT RISK: WHAT TO DO ? Once at risk, what to do ? 2019 table
  7. 7. OFFERED TOOLS Risk calculator Pereira-Azevedo Transl Androl Urol 2018 For free 30 – 40% biopsy less
  8. 8. OFFERED TOOLS Biological tests Van Oort. Prost Cancer Prost Dis 2017 Constant limitations Most studies: retrospective No clear definition of high risk disease (outside Gleason often > 7) Intrinsic test validity almost never done Cost effectiveness still questionable for many
  9. 9. Mp MRI: THE NEW TOOL mpMRI 2019 table Mp-MRI quality control: a must have
  10. 10. HOW OFTEN ? Intervals for early detection Individualized based on risk Unchanged in 2019
  11. 11. WHEN TO STOP ? When to stop ? Therefore no definitive age limit [Droz Eur Urol 2017] But comorbidities: the main discriminating factor Charlson comorbidity index: validated tool in PCa Unchanged in 2019
  12. 12. LOW RISK FINDING Dealing with overtreatment Intermediate risk Unchanged in 2019
  13. 13. TO CONCLUDE Finally Early diagnosis: only way to find "early" aggressive lesions Awareness of men Individualization and and counseling mandatory Cutting the link between diagnosis / treatment Clarifying clinically significant PCa to be improved

×