1. Prostate Cancer Screening Assistant Professor Charles Chabert Men’s health Seminar Ballina April 2011 prostates.com.au

2. What is the Prostate? Walnut sized gland under the bladder Shaped like a dognut Part of the male reproductive system prostates.com.au

3. What is Prostate Cancer? Malignant growth within the prostate Grows independently of normal body regulatory processes Has the ability to spread to other systems prostates.com.au

4. How common is Prostate cancer? Increasing incidence over the last 2 decades Around 20 000 new diagnoses each year Around 3000 deaths annually prostates.com.au

5. Age Family History Race Diet What are the Risk Factors? prostates.com.au

6. How is it detected? Prostate cancer is aymptomatic: development of urinary symptoms is a late feature Detected by combination of digital exam and PSA test prostates.com.au

7. The PSA Test PSA (Prostate Specific Antigen) is produced by the prostate Function of prostate is to liquify semen PSA Binds to serum proteins in the blood stream PSA is currently the best serum marker for prostate cancer prostates.com.au

8. An important part of screening Despite normal PSA, 25% of men with a abnormal DRE have prostate cancer Catalona WJ et al. 1994 Why should you perform a DRE? Digital Rectal Examination prostates.com.au

9. Localised disease is generally asymptomatic as the majority of cancers are located in the peripheral zone. Symptoms of LUTS are usually due to BPH, enlargement of the transitional zone. In locally advanced disease, large cancer volume may cause LUTS. What are the Presenting Symptoms?

10. An important part of screening Despite normal PSA, 25% of men with a abnormal DRE have prostate cancer Catalona WJ et al. 1994 Why should you perform a DRE? Digital Rectal Examination prostates.com.au

11.  For Testing  Against Testing Tests are simple (PSA, DRE) Detects cancer earlier, increasing chance of cure. Treating early CaP with surgery does improve survival Reassurance for patients with negative results False-positives cause anxiety and further testing Cancers can be missed Expensive and time-consuming Indolent cancers may be unnecessarily treated To Screen or Not To Screen prostates.com.au

12. Evidence as it stands ERSCP 12 year data 31.2% relative reduction in metastatic disease Swedish study shows 50% reduction in CAP mortality over 14 years 293 invited to screen 12 diagnosed to prevent 1 CAP death prostates.com.au

13. AgeMedian PSANormal Range 40-490.7ng/ml0-2.5ng/ml 50-590.9ng/ml0-3.5ng/ml 60-691.4ng/ml0-4.5ng/ml 70+0-6.5ng/ml Catalona AUA 2005 Abs 953, Oesterling JE et al 1993 Is this PSA normal? prostates.com.au

14. PSA Levels (ng/ml) Risk of Prostate Cancer in asymptomatic men 1.1- 2.017% 2.1- 3.024% 3.1- 4.0027% Adapted from Thompson, IM et al 2004 Risk of Prostate Cancer in Asymptomatic Men with Normal DRE? prostates.com.au

15. TransRectal Ultrasound (TRUS) guided biopsy performed under local anaesthetic TRUS-guided biopsy of prostate The Diagnosis prostates.com.au

16. Take Home Points Lifestyle modification PSA screening reduces the risk of dying from prostate cancer & reduces the risk of metastatic disease Urological Society recommendations: test from age 40years prostates.com.au

17. Questions? prostates.com.au The Prostate Clinic @Drcchabert