Week 5_prostate cancer

Question 1

What does PSA stand for?

Answer 1

Prostate Specific Antigen

Question 2

What is elevated PSA indicative of?

Answer 2

• Cancer
• benign prostatic hypertrophy
• Recent ejaculation
• bike riding

Question 3

Does having a normal PSA exclude Cancer?

Answer 3

no

Question 4

If a PSA result comes back positive, what is the next step?

Answer 4

• Digital REctal Examination (DRE)

> then referral to urologist > 6 blind prostate biopsies

Question 5

If biopsies come back clear, what does this mean for Pt?

Answer 5

• Pt requires regular testing in to the future.
• recurrences are common
• difficult to detect small cancers
• no evidence that screening save lives

Question 6

Of the 500,000 tests per year, how many are abnormal? vs how many die per year
How many new cases per year?
What % of men of 50 have prostate cancer?
How many men in 4 have symptoms?
What is the median age for diagnosis?
What risk do you have of metastatic cancer after 10 years?
What is the 10 year survival rate?
Early surgery saves?

Answer 6

• 500,000 tests per year, 1:10 abnormal
• How many die per year: 1:68 die/year (2500 people)
• How many new cases per year? 12,000 new cases per year, 2500 deaths/year
  -What % of men of 50 have prostate cancer? 40% of men > 50yo have prostate Ca.
• How many men in 4 have symptoms? 1:4 men have symptoms
• What is the median age for diagnosis? 71 yrs.
  80% of deaths occur in men > 70yo
  What risk do you have of metastatic cancer after 10 years? 13%
• 10 year survival rate (no treatment): 85%
• 1:12 saved by early surgery nnt=12

Question 7

What are the most common risk factors?

Answer 7

- Family history
    Av risk: 10%
    1 x 1st degree rel: 20%
    2 x 1st degree rel: 50%
    3 close degree rel: risk 
    approaches 100%
- Race
    - increased risk African Americans
    - decreased risk Chinese

Question 8

What is the sensitivity and specificity of testing PSA?

Answer 8

Sensitivity: 78%
Specificity: 93%

Question 9

List treatment options of prostate cancer

Answer 9

nb. Best treatment uncertain. Prostate cancer progresses slowly and mose with the disease die from other causes. We can’t predice who will benefit early treatment: we don’t know which cancers will be fatal.

1. Watch and wait
2. radical prostatectomy
3. radiation therapy/brachytherapy(beads of radiation shot into targeted area)
4. Hormone therapy ie. castration to remove estrogen source

Question 10

List side effects of prostate treatments:

Answer 10

• possible impotence (20-70%)
• possible incontinence (15-30%)
• chronic diarrhoea and rectal bleeding (radiation therapy/brachytherapy)

Question 11

Other than detection of PSA, what could result from a positive test?

Answer 11

• otherwise healthy men become cancer patients
• increased anxiety
• further tests and treatment: significant morbidity

Question 12

What are the current recommendations for prostate cancer screening?

How would a doctor decide who should be screened?

Answer 12

Screening not recommended by RACGP or WHO.

• no digital rectal examination
• no transabdominal ultrasound
• no PSA test: can detect but there are issues with sensitivity and specificity.

NHMRC guidelines acknowledge prostate cancer is a significant health issue, current situation far from idea.
PSA testing NOT recommended population wide.
No consensus on what PSA level to investigate.

A dr wouldn’t decide who should be screened. The patient should be informed of the potential benefits, risks and uncertainties of prostate cancer and make a decision on their own.

Question 13

Take home message for Prostate Cancer Screening/diagnosis

Answer 13

INFORMED CONSENT
- offer reassurance | anxiety over results
- early detection | lots of false negatives
early Rx |