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Published byElżbieta Drozd Modified over 5 years ago
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Prostate cancer screening beyond PSA – STHLM3 and/or MRI
Prostate cancer screening beyond PSA – STHLM3 and/or MRI? Goran Ahlgren, M.D. Ph.D. Lund University, Malmö Sweden
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Diagnostic goals 2017 To diagnose intermediate – high risk in time
To avoide overdiagnosis of low risk tumour To correctly classify tumour at diagnosis
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Why screening of prostate cancer?
Cancer i siffror 2015
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Almost 30% of 10 000 new cases yearly in Sweden is ”very low” or ”low risk”
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”Latent prostate cancer”
At autopsy a microscopic prostate cancer is detectable in Men years: 10% Men years: 20% Men years: 30% Men years: 40% Men years: 50% Men >80 years: 60%
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Avoide overdiagnosis = less biopsies!
Swedish guidelines: Biopsy not indicated if Normal DRE PSA 3-10 ng/ml (unless fast rise) PSA-f/T > 0,2 PSA-density < 0,1 ng/ml/cm3 BPH - Finasterid? If PSA rise: STHLM3? MRI?
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Andriole, J Urol 2006 (ARIA-studierna)
Effect of dutasteride on PSA-kinetic in patients with BPH and prostate cancer Andriole, J Urol 2006 (ARIA-studierna)
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Avoid Rebiopsy; Gothenburg part of the ERSPC study
322 with PSA >3 ng/ml without PCa at first biopsy. What happened? 56 normalised PSA (17%) 182 har benign repeat biopsies (56%) 84 had prostate cancer (26%) 2nd biopsy – 52/246 PCa (21,9%) 3rd biopsy – 32/194 PCa (16,5%) All patients with PSA >3ng/ml and a Prostate volume < 20cc hade PCa None of patients with P vol >70cc had PCa Zachrisson et al Eur Urol 2003;43
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Better use of PSA tests? STHLM0
EUROPEAN UROLOGY 6 3 ( ) – 4 2 5
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STHLM0 study shows that present PSA testing in Sweden also underdetects significant tumours
Percent of men with an elevated PSA that had a biopsy taken within 2 years from the first PSA above normal! PSA-value Age years Age years 3-4 45% 30% 4-10 65% 55% >10 70% 17.5% of all men who was diagnosed with advanced prostate cancer (T3/4, N1, M1, PSA>20) had a PSA ≥3 taken more than 6 months before without diagnostic action EUROPEAN UROLOGY 6 3 ( ) – 4 2 5
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Patients that had a prostate biopsy
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STHLM3 - algotithm
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STHLM3 is a algoritm for risk of significant prostate cancer
>10% risk för Sign cancer GS≥7
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Eur Urol 2016
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Eur Urol 2016
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Eur Urol 2016
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Can we trust a negative MRI??
Itatani, Eur J Radiol 2014 193 men with negative mpMRI = PI-RADS 1-2 F-U 5 years: PSA + biopsy + mpMRI NPV mpMRI: 90 %
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Conclusions STHLM3 can reduce benign biopsies with 44%
STHLM3 does not increase Gleason score ≥7 but reduces GS6 with 17% mpMRI double the significant cancer detection rate mpMRI significantly reduces the detection rate of GS6 cancer (≈50%) and benign biopsies (≈25-30%) Patients without clinical suspicion of prostate cancer should be evaluated with mpMRI
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