psa pathways bph
DESCRIPTION
PSA patterns and a BPH related case commonly seen in clinical practiceTRANSCRIPT
PSA PathwaysBPH 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
Prostate Histology
Gleason 3+3Prostate Cancer
BPH
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
• 61 yo man with moderate obstructive symptoms and PSA 4.5 Benign feeling 55gm prostate. Healthy otherwise
Assumes a 15 year life expectancyBPH symptoms predominate visitScreening data suggest to rule out cancer
Tuesday, January 19, 2010
Management Priority• Clinical BPH
• Confirm with PSA pattern
• Biopsy?
• If Family History, or PSA pattern
• Alpha Blocker
• Symptom Control
• What about 5ARI?
• Failure of Alpha Blocker, chemoprevention?
OK, Repeat PSA is 2.3----BPH
What if it came back at 4.8 and 5.0?
Patient wants to see a urologist, who repeats PSA and it’s 5.0Biopsy shows BPH in 12 Cores, suggests alpha Blocker and a follow up with Uroflow and PSA in 1 year
Before he see’s the Urologist patient says that he is no better. Wants PSA checked sooner. Change Alpha blocker? Add 5ARI?
What if I said there is a tablet that can shrink your prostate by 30%, decrease your risk of BPH surgery and reduce your risk of prostate cancer by 25%. OK, at what cost Doc?
Tuesday, January 19, 2010