CUA recommendations on Prostate Cancer Screening and Early Diangosis 2017

Question 1

Who should be offered PSA screening? as per CUA

Answer 1

Men with life expectancy more than 10 years. shared decision making is key either way.

Question 2

What does canadian task force say about PSA screening?

Answer 2

weak recommendation against it

Question 3

what are the key findings of PLCO?

Answer 3

No difference in Cancer specific survival after 15 years of follow up.
70,000 patients included
issues: 80% contamination.

Question 4

what were the key findings of ERSPC?

Answer 4

13 years FU
21% RRR in prostate cancer mortality
1.28 less death for every 1000 men screened. 27 men treated to prevent one prostate cancer death. Goteborg was a subgroup of this

Question 5

What were the findings of Goteborg group?

Answer 5

men 50-64,
RRR 42%
139 patietns screened to prevent one death

Question 6

At what age do you start Screening?

Answer 6

50 for most

45 at men with increased risk of PC( based on Goteborg)

Question 7

How should be screened at 45?

Answer 7

Those with family history in first or second degree relative

Question 8

What are 3 germline mutations associated with prostate cancer development

Answer 8

BRCA1,BRCA2, HOXB13

Question 9

what should be the interval between PSA screening?

Answer 9

PSA<1 : Q 4 years
PSA 1-3: Q 2 years
PSA >3 more frequent or adjunctive strategies

Question 10

Who can you stop PSA screening in?

Answer 10

Men aged 60 and PSA<1
For all men at age 70 ( can be considered in men with excellent health and age 70 but there is lack of empirical data)
For all men with life expectancy <10 years

Question 11

did Prostate cancer screening beyond age 70 result in reduction of mortality as per ERSPC?

Answer 11

No

Question 12

Is mpMRI targeted biopsy of prostate recommended in biopsy naive patient?

Answer 12

No it is not recommended, should not be done.

Question 13

What were the findings of PROMIS STUDY regarding mpMRI for screening?

Answer 13

had good specificity and NPV but poor PPV and sensitivity

Question 14

who should have a mpMRI guided biopsy?

Answer 14

patients with rising psa, new nodule and previously negative template biopsy, do MRI guided biopsy instead of repeat template

Question 15

what are recommendations regarding use of PSA velocity or PSADT?

Answer 15

CUA does not recommend using PSAV alone for clinical decision making in men undergoing routine screening however PSAV can provide additional information about patient risk of prostate cancer.
PSAV>0.75ng/ml/year can indicate an increase risk of prostate cancer,
Other study:
PSAV>0.35ng/ml/year when PSA<4 : higher risk of prostate ca death

Question 16

what is the role of PSAD? density

Answer 16

PSAD > 0.15 has been thought to be associated with adverse pathologic features
but due to lack of empirical evidence the use of it alone is discouraged and should be used as an adjunct

Question 17

what is the role of Percent free PSA?

Answer 17

in a study PFPSA<0.10 associated with 56% risk of cancer, PFPSA>0.25 only 8% risk of cancer
again its use alone is not recommended but can be used as an adjunct in elminating the risk of disease in men with elevated PSA

Question 18

Name 3 commercially available prostate biomarkers?

Answer 18

4K score(four kallikerin panel)
Prostate Health index
Prostate cancer antigen 3 score(PCA3 score)

Question 19

what are component of 4K score?

Answer 19

Total PSA, Free PSA, Intact PSA, Human kalkerein 2, age, DRE results, prior biopsy status
Generates risk of gleason >/=7 disease
validated for use in men with PSA<25

Question 20

what are PHI components

Answer 20

total PSA, Free PSA, 2 proPSA

originally developed to determine the risk of prostaet ca(GS>,=7) in PSa bw 2 and 10.

Question 21

What is PCa3?

Answer 21

it is a non-coding RNA gene only expressed in prostat, in urine measured after DRE, high rate of undiagnosed high grade cancers

Question 22

what is the role of PHI, 4K score and PCA3 test?

Answer 22

In men with a moderately elevated PSA, the 4Kscore,
PHI, and PCA3 may improve the prediction of clinically
significant prostate cancer and provide additional information
over PSA alone but expensive and not available in Canada,

Question 23

What are recommendations regarding Prostate risk calculators>

Answer 23

can be used to estimate the risk of clinically significant prostate cancer in men presenting with elevated psa
PCPT-RC
ESRPC-RC
and one based on Canadian men

Question 24

what percentage of patients with PSA >4 will have normal psa on repeat?

Answer 24

25%

so always double check psa prior to biopsy