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Nicolas Mottet: How to organize PSA screening


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European Prostate Cancer Awareness Day 2019

Published in: Health & Medicine
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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