PSA Screening

Question 1

PSA

Answer 1

• Serine protease of the kallikrein family
• Primarily produced by prostatic luminal epithelial cells
• Cleaves seminogelin (semin liquefication)
• Half-life: 2.2-3.2 days
• Androgen-dependent
• Within serum-bound and unboud
• PSA lvls vary based on age, race and prostate volume
• PSA test is not perfect and can only be used to define risk of prostate cancer

Question 2

What can elevate PSA

Answer 2

• Prostate ca
• BPH
• Infections (prostatitis, cystitis)
• Ejaculation
• Age
• dManipulation or trauma

Question 3

What can lower PSA

Answer 3

• 5-alpha reductase inhibitors
• Low serum testosterone
• Prostatic surgery
• Radiation therapy

Question 4

AUA guidelines for PSA testing by age

Answer 4

• <40: against, unless there are risk factors
• 40-54: against, unless there are risk factors
• 55-69: shared decision making; every 2yrs
• >70: against, unless they are in excellent health

Question 5

Advantages of PSA testing

Answer 5

• Early detection
• May prolong survival
• Early detection of aggressive disease
• No better tests?
• ERSPC trial foiund screening reduced the risk of death by >20% and the risk of metastatic prostate cancer by >40%

Question 6

Disadvantages of PSA testing

Answer 6

• Over-detection of indolent disease
• False pos.
• Testing assoc. w/ morbidity
• Over-treatment
• PLCO trial found no survival benefit for PSA based screening

Question 7

PHI test

Answer 7

• Mathematical formula that combines total, free and proPSA to determine risk of prostate cancer
• increasing PHI scores predict a greater risk of high risk pathology and biochemical recurrence following treatment

Question 8

Prostate cancer screening prediction models

Answer 8

• Risk calculators
• Prostate health index
• PCA3
• 4Kscore
• ConfirmMDx

Question 9

Prostate cancer prognosis prediction models

Answer 9

• OncotypeDx
• ConfirmMDx
• Decipher
• Prolaris

Question 10

Prostate cancer risk calculators

Answer 10

• PCPT
• ERSPC

Question 11

PCPT

Answer 11

• Prostate risk calculator
• For ages >55
• No previous diagnosis of prostate cancer needed
• DRE and PSA results less than 1 year old required

Question 12

ERSPC

Answer 12

• Prostate cancer risk calculator
• For 55-74
• No previous prostate cancer diagnosis needed
• No previous screening needed
• No previous biopsy required

Question 13

4K score test

Answer 13

• Prostate cancer screening prediction model
• Panel of 4 serum kallikrein markers (tPSA, fPSA, single chain iPSA, and hK2)
• Studied in men w/ PSA ranging from 3-10
• Initial out of pocket cost was >$1000
• Meta analytic data suggest that the 4K panel provides an 8-13% increase in predictive accuracy for high grade (>Gleason 7) disease and reduce the # of biopsies by 48-56%

Question 14

ConfirmMDX test

Answer 14

• Prostate cancer screening/prognosis prediction model
• Epigenetic assay (blood)

*methylation changes assoc. w/ the presence of cancer at the DNA lvl

• Help distinguish pts. who have a true-neg. biopsy from those who may have occult cancer
• 96% NPV for clinically significant cancer
• 90% NPV for all cancers

Question 15

PCA3 test

Answer 15

• Prostate cancer screening prediction model
• Non-coding, large chain RNA that is highly over-expressed in prostate cancer compared w/ noncancerous prostate tissue

*independent of age, prostate volume, and PSA

• Urine based test: mRNA expression in post-DRE urine
• Currently approved by the FDA in the setting of prior negative biopsy
• Threshold value of 20-35

Question 16

Prostate cancer is the ___ leading cause of death in men

Answer 16

• 2nd