Prostate Cancer Screening

Assistant Professor Charles ChabertMen’s health Seminar

BallinaApril 2011

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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