Prostate Cancer Update Robert Flynn

Screening No national screening policy Pros Early detection – reduced CaP mortality by 20% NNI 781 NND 27 at 13 years Cons Over detection/treatment of insignificant disease Morbidity of screening Advocate if family history – baseline PSA at 40 years.

Diagnosis DRE and PSA Pre-biopsy mpMRI Assessment of prostate volume and calculation of PSA density Identification of suspicious lesions – Pirads Scoring System Fusion biopsy of abnormal area(s) Transperineal Template biopsy if PSA density high ( > 0.15) and no abnormal focal areas.

mpMRI Prostate

Precision Trial

Active surveillance Preferred option for low risk disease cT1c, PSA < 10, Gleason Score < 6, < 2 cores, < 50% core length 70% remain on AS at 10 years Changing field mpMRI at enrolment mpMRI may replace subsequent biopsy Caution in younger men (<50 year old)

PSMA PET Novel imaging technology with increased detection rates PSA 0-0.19 : 33% +ve PSA 0.2-0.49 : 45% +ve PSA 0.5-0.99 ; 59% +ve PSA 1-1.99: 75% +ve PSA > 2 : 95% +ve Role Pre-treatment, especially in high risk patients Biochemical recurrence post radical treatment

PSMA PET

Prostate cancer service Rapid diagnostics Standard, fusion and Template prostate biopsies Weekly MDT meeting Urology cancer nurse support Latest Radiotherapy services Robotic Radical Prostatectomy