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Should I have that blood test for Prostate Cancer? PSA screening • Understand what the PSA test is • Identify when it should be used • Describe the pros and cons of PSA testing Prostate Cancer • Commonest cause of cancer in men in the UK • 2nd commonest cause of cancer death in men in the UK • Average age of diagnosis is 70 – 74 yrs of age • Much less common under 50 yrs of age • Average age of mortality is 80 – 84 yrs of age • 1 in 26 men in the UK will die from Prostate Cancer Risk Factors for Prostate Cancer • Age (strongest risk factor) • Family history – especially if relative diagnosed before age of 55 yrs – Also link to BRCA 1 and 2 so consider FHx breast cancer relative • Black men > 3 times more likely than white men (oriental/asian men lowest risk) • Diet inconclusive What is the PSA? A Glyccoprotein which liquefies semen and aids sperm motility PSA Testing • ANY man aged over 50 who requests a PSA after careful consideration should be tested • Expressed in benign and malignant conditions • Test benefits – Diagnose cancer before symptoms – Diagnose at a stage where could be cured or life extended – Serial measurements may help in diagnosis • Test limitations – PSA not diagnostic or tumour specific – False reassurance: 15% of men with a normal PSA will have Prostate Cancer and 2-3% will have high grade Prostate Cancer – Identification of cancers which may not become clinically evident in the patient’s lifetime Stats • Sensitivity (rules diagnosis in) – 21 % for all prostate cancers – 51 % for high grade prostate cancers – Using a PSA cut off of 4.0 • Specificity (rules diagnosis out) – 91 % for all prostate cancers – Using a PSA cut off of 4.0 • Positive Predictive Value (proportion of men with an elevated PSA who have Prostate Cancer) – 30 % for a PSA level of > 4.0 – Less than 1 in 3 men with a PSA of > 4.0 will have Prostate Cancer detected on biopsy Conditions for PSA testing • One should not check the PSA (has a half life of 2.2 days) – – – – – – During an active UTI If ejaculated within previous 48 hrs (rise of up to 0.8) If exercised vigourously within previous 48 hrs Had a DRE within 1 week (although some studies suggest minimal rise 0.26 –0.4) Had a Prostate Biopsy within 1 week (rise of 7.9) Nb 5 Alpha Reductase inihibitors may reduce PSA by 50% within 6 months DRE is useful for men with LUTS but not for asymptommatic men Referrals • If PSA raised above age specific limit – Refer Urology 2WW Questions?
