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Update on Prostate Cancer Senthil Kumaar GP VTS teaching Overview Background & Statistics Scenario 1 - Diagnosis & PSA testing Scenario 2 – possible treatment options Scenario 3 – important complications that we should know Summary Background & Stats How common is it ? - Commonest cancer in men (25 % of all cancers in men) - 2nd commonest cancer death after lung in men What are the risk factors ? - Age - Ethinicity – Black african/caribbean > White > south Asian - Family history - BRCA gene mutation No modifiable risk factors Incidence EU 27 – Age standardised incidence and mortality rates Trend Age at diagnosis Mortality rates Office for National Statistics. Cancer Statistics Registrations, England PSA screening – What’s the evidence? European RCT (ERSPC) – 9 yr interim results US study (PLCO) – 10 yr interim results Number Needed to Screen (NNS) - 1400 men to prevent one Pca death Number needed to treat (NNT) – 48 men to prevent one Pca death UK verdict – No evidence that Benefits outweigh harms GP Scenario 1 60 yr old requesting PSA test History ? Counselling ?? Benefits & Harm of PSA testing Benefits – early detection – early treatment - ? Extent life / cure Harms Unnecessary anxiety – only 1 in 3 with high PSA will have Pca Unnecessary investigations – biopsy / imaging, only 1 in 3 of Pca are likely to be clinically significant Unnecessary treatment – may lead to treatment of insignificant cancer which would not have clinically evident in the man’s lifetime. False reassurance – 2 out of 10 may have normal PSA and still have cancer. When to suspect Pca ? Unexplained Lower back pain Bone pain Wt loss in elderly ED Haematuria Abnormal DRE Raised PSA When to offer PSA ? Men > 50 , who ask for it Men with unexplained symptoms Men with obstructive LUTS When to do PSA test ? 4 weeks after infection 1 week after DRE 48 hrs after exercise/ / ejaculation Don’t forget DRE www.prosdex.com Counselling aid during consultation Gp Scenario 2 – pt requesting your opinion on treatment options Gp Scenario 3 – pt presenting with complications of Pca Medical Emergency - Spinal cord compression - Acute / chronic retention Summary Increased incidence due to better diagnosis, but no significant change in mortality rate PSA national screening (UK policy) – Harm outweigh benefits Opportunistic PSA screening after appropriate counselling All treatment options have adverse effects including active surveillence All these might change in near future – UK 15 yr study (ProTect trial) are publishing their results next year (2013).