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Prostate Cancer Update

Prostate Cancer Update. Robert Flynn. 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

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Prostate Cancer Update

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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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