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Prostate Cancer What a GP Needs to Know

Prostate Cancer What a GP Needs to Know. Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Westmead Public and Private Hospital Senior Lecturer, University of Sydney. Prostate Cancer What a GP Needs to Know. Prostate Cancer Screening What you need to tell your patients.

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Prostate Cancer What a GP Needs to Know

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  1. Prostate CancerWhat a GP Needs to Know Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Westmead Public and Private Hospital Senior Lecturer, University of Sydney

  2. Prostate CancerWhat a GP Needs to Know • Prostate Cancer Screening • What you need to tell your patients. • The PSA test • When to refer to a urologist. • Localised Prostate Cancer • What are the newest modalities? • Androgen Deprivation Therapy • How to monitor these men.

  3. 1. Prostate Cancer ScreeningWhat you need to tell your patients. • Mr J.B. 57 year old. • Mild LUTS • Hypertension • Asks his G.P. whether he needs a test for prostate cancer? • What should the G.P discuss with him?

  4. 1. Prostate Cancer ScreeningWhat you need to tell your patients. • PSA • Blood test • Can detect early Cancer • Digital Rectal Exam • Important • 15% of cancers have “normal” PSA but abnormal DRE.

  5. PSA screening detects cancers earlier. Treating early CaP improves survival. Negative results reduce anxiety Test is easy to administer False positives are common. Indolent cancers are treated inadvertently 1. Prostate Cancer ScreeningWhat you need to tell your patients. PotentialBenefits PotentialHarms Need to discuss the individual benefits and risks of screening with all male patients 50-70years.

  6. 2. The PSA Test-When to Refer to a Urologist. Risk of Prostate Cancer in Men with Normal DRE

  7. 2. The PSA testWhen to refer to a urologist. Age Median PSA Normal Range 40-49 0.7ng/ml 0-2.5ng/ml 50-59 0.9ng/ml 0-3.5ng/ml 60-69 1.2ng/ml 0-4.5ng/ml 70+ 1.4ng/ml 0-6.5ng/ml

  8. 2. The PSA test- When to refer to a urologist.Free to Total (%) Does Help Specificity.

  9. 2. The PSA test- When to refer to a urologist.PSA Velocity is important to calculate • Men with PSA below 4.0ng/ml • PSA velocity > 10%/yr =30% risk CaP • PSA velocity >0.4ng/ml/yr = 45% risk CaP • PSA velocity >2.0ng/ml/yr = high risk of death • More accurate with multiple measures over time.

  10. 2. The PSA test- When to refer to a urologist.Suggested Algorithm

  11. 3. Localised Prostate Cancer-Options of Treatment • Active Surveillance • Radical Prostatectomy • Seed Brachytherapy • External Beam Radiotherapy +/- hormone deprivation. • HDR Brachytherapy • HIFU (High Intensity Focused Ultrasound) • Watchful Waiting

  12. 3. Localised Prostate Cancer-Active Surveillance 99% 8year disease specific survival • Advantages: • Avoid treatment in 50% of men • Only treat men who need treatment • Disadvantages • Anxiety • Possibility of “missing the window of opportunity” Patel et.al. J Urol. 2004;171(4):1520

  13. 3. Localised Prostate Cancer-Radical Prostatectomy • Advantages: • Good cure rate • Quick recovery in young men • Salvage XRT • Disadvantages • Possible incontinence • Possible impotence Prostate NVB Rectum

  14. 3. Localised Prostate Cancer-Robotic or Laparoscopic Radical Prostatectomy • Advantages • Less blood loss • 1 day less hospital stay • Disadvantages • Unable to palpate the cancer (Positive margin) • Poorer continence and potency • Learning curve • Expensive

  15. 3. Localised Prostate Cancer-Brachytherapy Prostate • Advantages: • Minor procedure • Disadvantages • Only for low risk • Urinary symptoms • Rectal symptoms • Unable to have surgery afterwards Urethra Rectum

  16. 3. Localised Prostate Cancer-External Beam Radiotherapy • Advantages: • Minor procedure • Disadvantages • 7 weeks treatment • May need hormones • Urinary symptoms • Rectal symptoms • Unable to have surgery afterwards

  17. 3. Localised Prostate Cancer-HDR Brachytherapy • Advantages: • Good treatment of high risk disease • Disadvantages • Need hormones • 5 weeks EBRT • Urinary symptoms • Rectal symptoms • Unable to have surgery afterwards

  18. 3. Localised Prostate Cancer-HIFU • Advantages: • Minimally invasive • Similar cure to XRT • High continence and potency • Repeatable procedure • Disadvantages • Expensive • Experimental

  19. 4. Androgen Deprivation TherapyHow to Monitor These Men.

  20. Summary • Prostate Cancer Screening • Tell your patients all the Pros and Cons. • The PSA test • Criteria will continue changing • Divide in to Definite, Possible and Watch categories. • Localised Prostate Cancer • Lots of new modalities • Androgen Deprivation Therapy • Monitor their cardiac and bone health

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