1. Prostate Cancer Update
Robert Flynn

2. 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.

3. 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.

4. mpMRI Prostate

5. Precision Trial

6. 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)

7. PSMA PET Novel imaging technology with increased detection rates
PSA : 33% +ve
PSA : 45% +ve
PSA ; 59% +ve
PSA : 75% +ve
PSA > 2 : 95% +ve
Role
Pre-treatment, especially in high risk patients
Biochemical recurrence post radical treatment

8. PSMA PET

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