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  • PSA Pathways BPH

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    Chris French
    744 vizualizări10 pagini
    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

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    PSA patterns and a BPH related case commonly seen in clinical practice

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    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    744 vizualizări10 pagini

    PSA Pathways BPH

    Încărcat de

    Chris French
    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    din 10

    PSA Pathways

    BPH and Prostate Cancer


    Christopher French MD FRCSC

    Tuesday, January 19, 2010


    PSA Utility

    • A Screening Tool

    • A Staging Tool

    • A Post Treatment
    Marker

    Tuesday, January 19, 2010


    PSA Biology
    • A surrogate for benign enlargement

    • Spike rises and falls in inflammation/


    BPH

    • A persistent rise above age adjusted


    limits ,not explained by a pattern of BPH,
    is associated with a 40% risk of cancer.

    • High grade cancers (gleason 9 or 10) are


    typically not represented in the PSA level.

    Tuesday, January 19, 2010


    PSA Biology

    Tuesday, January 19, 2010


    BPH

    Gleason 3+3
    Prostate
    Cancer

    Prostate Histology
    Tuesday, January 19, 2010
    Recent Screening
    Studies
    • PLCO

    • Annual Screening vs Current Standard

    • After 7-10 years the mortality rates were


    similar

    • ERSPC

    • Annual Screening vs unscreened control

    • 20% reduction in prostate cancer mortality

    Tuesday, January 19, 2010


    Mortality Benefits of
    Screening

    • Benefits of
    screening have to
    weighed against a
    potential 50%
    incidence of non life
    threatening cancers.

    Tuesday, January 19, 2010


    Prostate Cancer
    screening future

    • Individualize the screening process

    • Consider PSA patterns not single PSA

    • Family history

    • Educate on the safety of Active Surveillance

    • Implement tools to complement PSA

    • Chemoprevention

    Tuesday, January 19, 2010


    PSA Case 1

    Assumes a 15 year life


    expectancy
    BPH symptoms predominate
    • 61 yo man with visit
    Screening data suggest to
    moderate rule out cancer

    obstructive
    symptoms and PSA
    4.5 Benign feeling
    55gm prostate.
    Healthy otherwise

    Tuesday, January 19, 2010


    Management Priority
    • Clinical BPH OK, Repeat PSA is 2.3----BPH

    What if it came back at 4.8 and 5.0?


    • Confirm with PSA pattern
    Patient wants to see a urologist, who repeats PSA and
    • Biopsy? it’s 5.0
    Biopsy shows BPH in 12 Cores, suggests alpha Blocker
    and a follow up with Uroflow and PSA in 1 year

    • If Family History, or PSA pattern

    • Alpha Blocker Before he see’s the Urologist patient says that he


    is no better. Wants PSA checked sooner. Change
    Alpha blocker? Add 5ARI?
    • Symptom Control
    What if I said there is a tablet that can shrink
    • What about 5ARI? your prostate by 30%, decrease your risk of BPH
    surgery and reduce your risk of prostate cancer
    by 25%. OK, at what cost Doc?

    • Failure of Alpha Blocker, chemoprevention?


    Tuesday, January 19, 2010

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