Prostate Cancer Screening. Google Search “Prostate Cancer” “Google Health” prostate cancer (OK) “Should All Men Be Screened for Prostate Cancer?” ABC

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  • Prostate Cancer Screening

  • Google Search Prostate CancerGoogle Health prostate cancer (OK)Should All Men Be Screened for Prostate Cancer? ABC news

  • Prostate Cancer ReviewMost common non-dermatologic malignancy in US men2nd most common cause of cancer related death in US men218 K new cases/ year in US detected23 K deaths/ year estimate by ACS in 2006PSA approved 1986Mortality peaked in 1991, now declining

  • Incidence

  • Mortality

  • Prostate Screening ReviewProstate cancer screening is controversialPositive screening considered potentially harmfulPSA anxietyPhysical risks of biopsyProstate cancer treatment is controversial

  • Where we should all agreeScreening implies asymptomatic men Men with a less than 10-15 year life expectancy should not be screenedIn general in US men>75Men with terminal illnessMen with life threatening illnessDont get PSA as inflammation marker

  • Notes about PSASerine proteaseChymotrypsin likeNormal function is to liquefy semen to facilitate spermatozoa movementThe U.S. Food and Drug Administration (FDA) has approved the use of the PSA test along with a digital rectal exam (DRE) to help detect prostate cancer in men 50 years of age or older. Medicare covers annual testing starting age 50.

  • DRE is Important

  • PSA as a test75% sensitiveWhy DRE needed25% specific1/4 to 1/3 have positive biopsy (20-56% FP mammogram over 10 years)

  • PSA: Different Views> 4 abnormalAge adjusted:40s > 2.5 abnormal50s> 3.5 abnormalPSA velocity:>0.75 ng/ml/yr abnormal>0.35 ng/ml/yr abnormal

  • Studies relating mortalityPCLO: multicenter prospective RCT in US:Annual screening (6 years PSA, 4 DRE) usual treatment (40% were screened)ERSPC: multicenter prospective RCT in Europe:Annual Screening vs no screeningMore varied screening frequencyNote traditionally screening supported in US not in Europe.

  • Studies relating mortality: PLCO

  • Studies relating mortality

  • Studies relating mortality

  • Studies relating mortality: ERSPC

  • Studies relating mortality: ERSPC

  • Studies relating mortality: ERSPCNNS to prevent 1 death 1410 (although only 1 study)

  • Studies relating mortality: ERSPCSubsequent paper estimated difference after non compliance (20%- screening arm) and contamination (30% of control arm) were excludedIn this analysis 30% reduction of mortality.

  • Just for perspective.Same search: Cholesterol screening mortality cochrane: 12 papers, none about cholesterol screening2007 Cochrane Review (update from 2004): No evidence to support dietary modification in type 2 DM (some for exercise)USPHTF does not recommend for or against screening women not at increased CAD risk for lipid disorders.

  • Breast Cancer

  • Breast CancerNNS to prevent 1 death> 50 1224NNS to prevent 1 death
  • SummaryDo evaluate men with symptomsProstate Cancer Screening of asymptomatic men is controversialDiscuss with patientsIf done, do a DRE too!If abnormal screen, refer to usWe can counsel about R/B/A biopsyWe can counsel about over and under treatment

  • Useful Resourceshttp://www.cancer.gov/cancertopics/factsheet/detection/PSAhttp://www.ahrq.gov/clinic/uspstf/uspsprca.htmhttp://seer.cancer.gov/statistics/types.html