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Prostate Cancer Screening. Google Search “Prostate Cancer”. “Google Health” prostate cancer (OK) “Should All Men Be Screened for Prostate Cancer?” ABC news. Prostate Cancer Review. Most common non-dermatologic malignancy in US men 2 nd most common cause of cancer related death in US men
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Google Search “Prostate Cancer” • “Google Health” prostate cancer (OK) • “Should All Men Be Screened for Prostate Cancer?” ABC news
Prostate Cancer Review • Most common non-dermatologic malignancy in US men • 2nd most common cause of cancer related death in US men • 218 K new cases/ year in US detected • 23 K deaths/ year estimate by ACS in 2006 • PSA approved 1986 • Mortality peaked in 1991, now declining
Prostate Screening Review • Prostate cancer screening is controversial • Positive screening considered potentially harmful • PSA anxiety • Physical risks of biopsy • Prostate cancer treatment is controversial
Where we should all agree • “Screening” implies asymptomatic men • Men with a less than 10-15 year life expectancy should not be screened • In general in US men>75 • Men with terminal illness • Men with life threatening illness • Don’t get PSA as inflammation marker
Notes about PSA • Serine protease • Chymotrypsin like • Normal function is to liquefy semen to facilitate spermatozoa movement • The 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.
PSA as a test • 75% sensitive • Why DRE needed • 25% specific • 1/4 to 1/3 have positive biopsy • (20-56% FP mammogram over 10 years)
PSA: Different Views • > 4 abnormal • Age adjusted: • 40s > 2.5 abnormal • 50’s> 3.5 abnormal • PSA velocity: • >0.75 ng/ml/yr abnormal • >0.35 ng/ml/yr abnormal
Studies relating mortality • PCLO: 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 screening • More varied screening frequency • Note traditionally screening supported in US not in Europe….
Studies relating mortality: ERSPC NNS to prevent 1 death 1410 (although only 1 study)
Studies relating mortality: ERSPC • Subsequent paper estimated difference after non compliance (20%- screening arm) and contamination (30% of control arm) were excluded • In this analysis 30% reduction of mortality.
Just for perspective…. • Same search: Cholesterol screening mortality cochrane: 12 papers, none about cholesterol screening • 2007 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 NNS to prevent 1 death> 50 1224 NNS to prevent 1 death <40 1792
Summary • Do evaluate men with symptoms • Prostate Cancer Screening of asymptomatic men is controversial • Discuss with patients • If done, do a DRE too! • If abnormal screen, refer to us • We can counsel about R/B/A biopsy • We can counsel about over and under treatment
Useful Resources • http://www.cancer.gov/cancertopics/factsheet/detection/PSA • http://www.ahrq.gov/clinic/uspstf/uspsprca.htm • http://seer.cancer.gov/statistics/types.html