Should I have that blood test for Prostate Cancer?

PSA screening Understand what the PSA test is Identify when it should be used Describe the pros and cons of PSA testing

Prostate Cancer Commonest cause of cancer in men in the UK 2 nd commonest cause of cancer death in men in the UK Average age of diagnosis is 70 – 74 yrs of age Much less common under 50 yrs of age Average age of mortality is 80 – 84 yrs of age 1 in 26 men in the UK will die from Prostate Cancer

Risk Factors for Prostate Cancer Age (strongest risk factor) Family history – especially if relative diagnosed before age of 55 yrs –Also link to BRCA 1 and 2 so consider FHx breast cancer relative Black men > 3 times more likely than white men (oriental/asian men lowest risk) Diet inconclusive

What is the PSA? A Glyccoprotein which liquefies semen and aids sperm motility

PSA Testing ANY man aged over 50 who requests a PSA after careful consideration should be tested Expressed in benign and malignant conditions Test benefits –Diagnose cancer before symptoms –Diagnose at a stage where could be cured or life extended –Serial measurements may help in diagnosis Test limitations –PSA not diagnostic or tumour specific –False reassurance: 15% of men with a normal PSA will have Prostate Cancer and 2-3% will have high grade Prostate Cancer –Identification of cancers which may not become clinically evident in the patient’s lifetime

Stats Sensitivity (rules diagnosis in) –21 % for all prostate cancers –51 % for high grade prostate cancers –Using a PSA cut off of 4.0 Specificity (rules diagnosis out) –91 % for all prostate cancers –Using a PSA cut off of 4.0 Positive Predictive Value (proportion of men with an elevated PSA who have Prostate Cancer) –30 % for a PSA level of > 4.0 –Less than 1 in 3 men with a PSA of > 4.0 will have Prostate Cancer detected on biopsy

Conditions for PSA testing One should not check the PSA (has a half life of 2.2 days) –During an active UTI –If ejaculated within previous 48 hrs (rise of up to 0.8) –If exercised vigourously within previous 48 hrs –Had a DRE within 1 week (although some studies suggest minimal rise 0.26 –0.4) –Had a Prostate Biopsy within 1 week (rise of 7.9) –Nb 5 Alpha Reductase inihibitors may reduce PSA by 50% within 6 months DRE is useful for men with LUTS but not for asymptommatic men

Referrals If PSA raised above age specific limit –Refer Urology 2WW

Questions?