Prostate Cancer Screening
Assistant Professor Charles ChabertMen’s health Seminar
BallinaApril 2011
prostates.com.au
What is the Prostate?
Walnut sized gland under the bladder
Shaped like a dognut
Part of the male reproductive system
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What is Prostate Cancer?
• Malignant growth within the prostate
• Grows independently of normal body regulatory processes
• Has the ability to spread to other systems
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How common is Prostate cancer?
• Increasing incidence over the last 2 decades
• Around 20 000 new diagnoses each year
• Around 3000 deaths annually
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• Age
• Family History
• Race
• Diet
What are the Risk Factors?
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How is it detected?
• Prostate cancer is aymptomatic: development of urinary symptoms is a late feature
• Detected by combination of digital exam and PSA test
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The PSA Test
• PSA (Prostate Specific Antigen) is produced by the prostate
• Function of prostate is to liquify semen
• PSA Binds to serum proteins in the blood stream
• PSA is currently the best serum marker for prostate cancer
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• An important part of screening
• Despite normal PSA, 25% of men with a abnormal DRE have prostate cancer
Catalona WJ et al. 1994
Why should you perform a DRE?
Digital Rectal Examination
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• Localised disease is generally asymptomatic as the majority of cancers are located in the peripheral zone.
• Symptoms of LUTS are usually due to BPH, enlargement of the transitional zone.
• In locally advanced disease, large cancer volume may cause LUTS.
What are the Presenting Symptoms?
• An important part of screening
• Despite normal PSA, 25% of men with a abnormal DRE have prostate cancer
Catalona WJ et al. 1994
Why should you perform a DRE?
Digital Rectal Examination
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For Testing Against Testing• Tests are simple (PSA, DRE)• Detects cancer earlier,
increasing chance of cure.• Treating early CaP with surgery
does improve survival• Reassurance for patients with
negative results
• False-positives cause anxiety and further testing
• Cancers can be missed• Expensive and time-consuming• Indolent cancers may be
unnecessarily treated
To Screen or Not To Screen
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Evidence as it stands
• ERSCP 12 year data• 31.2% relative reduction in metastatic disease
• Swedish study shows 50% reduction in CAP mortality over 14 years
• 293 invited to screen• 12 diagnosed to prevent 1 CAP death
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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 1.4ng/ml 0-4.5ng/ml
70+ 0-6.5ng/ml
Catalona AUA 2005 Abs 953, Oesterling JE et al 1993
Is this PSA normal?
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PSA Levels (ng/ml)Risk of Prostate
Cancer in asymptomatic men
1.1- 2.0 17%
2.1- 3.0 24%
3.1- 4.00 27%
Adapted from Thompson, IM et al 2004
Risk of Prostate Cancer in Asymptomatic Men with Normal DRE?
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• TransRectal Ultrasound (TRUS)
guided biopsy performed under local anaesthetic
TRUS-guided biopsy of prostate
The Diagnosis
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Take Home Points
• Lifestyle modification• PSA screening reduces the risk of dying from
prostate cancer & reduces the risk of metastatic disease
• Urological Society recommendations: test from age 40years
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Questions?
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The Prostate Clinic @Drcchabert