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Prostate Cancer Update: Screening, Diagnosis, and Treatment Advances

This update covers the latest in prostate cancer management, from screening controversies to precision diagnosis techniques like mpMRI and PSMA PET imaging. Learn about active surveillance, treatment options, and the role of PSMA PET in guiding therapy.

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Prostate Cancer Update: Screening, Diagnosis, and Treatment Advances

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  1. Prostate Cancer Update Robert Flynn

  2. Screening • No national screening policy • Pros • Early detection – reduced CaP mortality by 20% • NNI 781 NND 27 at 13 years • Cons • Over detection/treatment of insignificant disease • Morbidity of screening • Advocate if family history – baseline PSA at 40 years.

  3. Diagnosis • DRE and PSA • Pre-biopsy mpMRI • Assessment of prostate volume and calculation of PSA density • Identification of suspicious lesions – Pirads Scoring System • Fusion biopsy of abnormal area(s) • Transperineal Template biopsy if PSA density high ( > 0.15) and no abnormal focal areas.

  4. mpMRI Prostate

  5. Precision Trial

  6. Active surveillance • Preferred option for low risk disease • cT1c, PSA < 10, Gleason Score < 6, < 2 cores, < 50% core length • 70% remain on AS at 10 years • Changing field • mpMRI at enrolment • mpMRI may replace subsequent biopsy • Caution in younger men (<50 year old)

  7. PSMA PET • Novel imaging technology with increased detection rates • PSA 0-0.19 : 33% +ve • PSA 0.2-0.49 : 45% +ve • PSA 0.5-0.99 ; 59% +ve • PSA 1-1.99: 75% +ve • PSA > 2 : 95% +ve • Role • Pre-treatment, especially in high risk patients • Biochemical recurrence post radical treatment

  8. PSMA PET

  9. Prostate cancer service • Rapid diagnostics • Standard, fusion and Template prostate biopsies • Weekly MDT meeting • Urology cancer nurse support • Latest Radiotherapy services • Robotic Radical Prostatectomy

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