Prostate Screening in Prostate Screening in the New Millenniumthe New Millennium

Dr Pamela AjayiDr Pamela AjayiMD PathCare MD PathCare

The Prostate GlandThe Prostate Gland

Why screen?Why screen?

"Prostate cancer comes in a "Prostate cancer comes in a number of forms, some number of forms, some aggressive and some not…“aggressive and some not…“

“…“…but the bottom line about but the bottom line about prostate cancer testing is that prostate cancer testing is that we cannot counsel patients we cannot counsel patients about next steps for cancer that about next steps for cancer that we do not know existswe do not know exists.“ .“

What is screening?What is screening?

A screening test A screening test separates apparently separates apparently healthy persons who healthy persons who probably probably have a have a disease from those disease from those who probably do not.who probably do not.

Screening Screening

Digital Rectal Digital Rectal ExaminationExamination• LumpsLumps• HardnessHardness• Increased sizeIncreased size

Screening Screening

Blood test to measure PSA Blood test to measure PSA is considered the most is considered the most effective test currently effective test currently available for the early available for the early detection of prostate detection of prostate cancer.cancer.

PSA LevelsPSA Levels(N: <4ng/ml)(N: <4ng/ml)

(B: 4 - 10ng/ml)(B: 4 - 10ng/ml)

(A: >10ng/ml)(A: >10ng/ml)

PSAPSA

PSA levels can be often elevated in the PSA levels can be often elevated in the presence of prostate cancer and in presence of prostate cancer and in other prostate disorders. other prostate disorders. • prostate infection / inflammationprostate infection / inflammation• benign prostatic hyperplasia (BPH)benign prostatic hyperplasia (BPH)• recent ejaculationrecent ejaculation• Digital rectal examination (DRE) Digital rectal examination (DRE)

**Elevated PSA levels do not necessarily**Elevated PSA levels do not necessarily

mean you have cancer! mean you have cancer!

Also…Also…

Prostate cancer can also be present Prostate cancer can also be present in the in the complete absencecomplete absence of an of an elevated PSA level, in which case the elevated PSA level, in which case the test result would be a false negative.test result would be a false negative.

Obesity has been reported to reduce Obesity has been reported to reduce serum PSA levels. serum PSA levels.

Free PSAFree PSA Most PSA in the blood is bound to Most PSA in the blood is bound to

serum proteins. serum proteins. A small amount is not protein A small amount is not protein

bound and is called bound and is called free PSAfree PSA.. In men with prostate cancer the In men with prostate cancer the

ratio of free (unbound) PSA to ratio of free (unbound) PSA to total PSA is decreased. total PSA is decreased. • The risk of cancer increases if the The risk of cancer increases if the

free to total ratio is less than 25%. free to total ratio is less than 25%. • The lower the ratio the greater the The lower the ratio the greater the

probability of prostate cancer.probability of prostate cancer.

Measuring the ratio of free to Measuring the ratio of free to total PSA appears to be total PSA appears to be particularly promising for particularly promising for eliminating unnecessary biopsies eliminating unnecessary biopsies in men with PSA levels between 4 in men with PSA levels between 4 and 10 ng/mL levels and 10 ng/mL levels

Recommendations:Recommendations:American Urological Association:American Urological Association: Early detection and risk evaluation of prostate cancer should be offered to well-informed men Early detection and risk evaluation of prostate cancer should be offered to well-informed men

40 years of age or older who have a life expectancy of at least 10 years. 40 years of age or older who have a life expectancy of at least 10 years. • The future risk of prostate cancer is closely correlation to a man's PSA score; a baseline PSA level above The future risk of prostate cancer is closely correlation to a man's PSA score; a baseline PSA level above

the median for age 40 is a strong predictor of prostate cancer. the median for age 40 is a strong predictor of prostate cancer.

““In regard to biopsy, a continuum of risk exists at all values, and major studies have In regard to biopsy, a continuum of risk exists at all values, and major studies have demonstrated that there is no safe PSA value below which a man appears to be reassured that demonstrated that there is no safe PSA value below which a man appears to be reassured that he does not have biopsy-detectable prostate cancer. Therefore, the AUA does not recommend a he does not have biopsy-detectable prostate cancer. Therefore, the AUA does not recommend a single PSA threshold at which a biopsy should be obtained. Rather, the decision to biopsy single PSA threshold at which a biopsy should be obtained. Rather, the decision to biopsy should take into account additional factors, including free and total PSA, PSA velocity and should take into account additional factors, including free and total PSA, PSA velocity and density, patient age, family history, race/ethnicity, prior biopsy history and co-morbidities. density, patient age, family history, race/ethnicity, prior biopsy history and co-morbidities. Additionally, the AUA statement emphasizes that not all prostate cancers require active Additionally, the AUA statement emphasizes that not all prostate cancers require active therapy and that not all prostate cancers are life-threatening. The decision to proceed to active therapy and that not all prostate cancers are life-threatening. The decision to proceed to active therapys is one that men should discuss in detail with their urologists to determine whether therapys is one that men should discuss in detail with their urologists to determine whether active therapy is necessary, or whether surveillance appears to be an option for their prostate active therapy is necessary, or whether surveillance appears to be an option for their prostate cancer. cancer.

Additionally, the Best Practice Statement clarifies many key points about the use of PSA in Additionally, the Best Practice Statement clarifies many key points about the use of PSA in therapy selection and post-treatment follow up of patients with prostate cancer: therapy selection and post-treatment follow up of patients with prostate cancer:

Men who wish to be screened for Men who wish to be screened for prostate cancer should have both a PSA prostate cancer should have both a PSA test and a digital rectal exam (DRE). test and a digital rectal exam (DRE).

Family history, age, overall health and Family history, age, overall health and ethnicity should be combined with the ethnicity should be combined with the results of PSA testing and physical results of PSA testing and physical examination in order to better examination in order to better determine the risk of prostate cancer. determine the risk of prostate cancer.

Informed decision makingInformed decision making

Informed decision making occurs when Informed decision making occurs when a man—a man—• Understands the nature and risk of Understands the nature and risk of

prostate cancer.prostate cancer.• Understands the risks of, benefits of, and Understands the risks of, benefits of, and

alternatives to screening.alternatives to screening.• Participates in the decision to be screened Participates in the decision to be screened

or not at a level he desires.or not at a level he desires.• Makes a decision consistent with his Makes a decision consistent with his

preferences and values.preferences and values.

Understanding Prostate CancerUnderstanding Prostate Cancer

Signs and Signs and symptomssymptoms

Risk factorsRisk factors DiagnosisDiagnosis Treatment:Treatment:

• Complications Complications • BenefitsBenefits

Symptoms Symptoms NoneNone

If symptoms appear, they can If symptoms appear, they can include: include:

■ ■ blood in the urine; blood in the urine; ■ ■ the need to urinate the need to urinate

frequently, especially at frequently, especially at night; night;

■ ■ weak or interrupted urine weak or interrupted urine flow; flow;

■ ■ pain or burning feeling pain or burning feeling while urinating; while urinating;

■ ■ the inability to urinate; the inability to urinate; ■ ■ constant pain in lower constant pain in lower

back, pelvis, or upper thighs. back, pelvis, or upper thighs.

Risk FactorsRisk Factors

EthnicityEthnicity Family HistoryFamily History AgeAge Other factors:Other factors:

• SmokingSmoking• DietDiet• ExerciseExercise

Ethnic risk Ethnic risk

Increased riskIncreased risk Increased Increased

mortality & mortality & morbiditymorbidity

Possible reasons:Possible reasons:• ?Culture?Culture• ?Environment?Environment• ?Genetic?Genetic

Prostate cancer death rates by race/ethnicity in males aged 45 and above. (CDC)

Diagnosing Prostate CancerDiagnosing Prostate Cancer

ScreeningScreening Ultrasound scan & Ultrasound scan &

Confirmatory Confirmatory BiopsyBiopsy• Gleason scaleGleason scale• StagingStaging

RadiologyRadiology• Bone scanBone scan• CTCT• MRIMRI

Types of Cancer Types of Cancer

Some prostate cancers become a serious Some prostate cancers become a serious threat to health by growing quickly, threat to health by growing quickly, spreading beyond the prostate gland to spreading beyond the prostate gland to other parts of the body, and causing other parts of the body, and causing death. death.

Other prostate cancers grow slowly and Other prostate cancers grow slowly and never become a serious health threat or never become a serious health threat or affect how long a man lives. affect how long a man lives.

**Doctors can’t always be sure what type **Doctors can’t always be sure what type of cancer is present in a particular case. of cancer is present in a particular case.

TreatmentTreatment

BrachytherapyBrachytherapy External Beam Radiation TherapyExternal Beam Radiation Therapy Hormonal TherapyHormonal Therapy Radical Prostatectomy (?Radical Prostatectomy (?

Laparoscopic)Laparoscopic)

ComplicationsComplications• ContinenceContinence• Sexual functionSexual function

http://www.londonurologicalpractice.comhttp://www.cdc.gov/cancer/prostate/pdf/aaprosguide.pdf

Get Tested!Get Tested!

ANNUALLYANNUALLY

THANK YOUTHANK YOU

PathCarePathCare Plot 1397b Tiamiyu Savage St VIPlot 1397b Tiamiyu Savage St VI

01-461 6311/4610434/461043501-461 6311/4610434/4610435

www.pathcarenigeria.comwww.pathcarenigeria.com