Presentation on theme: "Prostate Cancer What a GP Needs to Know"— Presentation transcript:
1Prostate Cancer What a GP Needs to Know Dr Manish PatelUrological Cancer SurgeonSydney Adventist HospitalWestmead Public and Private HospitalSenior Lecturer, University of Sydney
2Prostate Cancer What a GP Needs to Know Prostate Cancer ScreeningWhat you need to tell your patients.The PSA testWhen to refer to a urologist.Localised Prostate CancerWhat are the newest modalities?Androgen Deprivation TherapyHow to monitor these men.
31. Prostate Cancer Screening What you need to tell your patients. Mr J.B. 57 year old.Mild LUTSHypertensionAsks his G.P. whether he needs a test for prostate cancer?What should the G.P discuss with him?
41. Prostate Cancer Screening What you need to tell your patients. PSABlood testCan detect early CancerDigital Rectal ExamImportant15% of cancers have “normal” PSA but abnormal DRE.
51. Prostate Cancer Screening What you need to tell your patients. Potential BenefitsPotential HarmsFalse positives are common.Indolent cancers are treated inadvertentlyPSA screening detects cancers earlier.Treating early CaP improves survival.Negative results reduce anxietyTest is easy to administerWhat we have attempted to show here is a balance between the potential benefits and harms or side effects of screening and early treatment.On the benefits side, evidence appears strong that PSA screening leads to early detection of prostate cancer. There is evidence that treating PSA-detected prostate cancer may be effective in reducing the likelihood that patients will die from the disease, but other evidence makes this uncertain. PSA use may contribute to the decline in U.S. prostate cancer mortality, but the evidence is not consistent.For harms or side effects, false positives are common. Overdiagnosis is a problem, but we are uncertain about the magnitude. Treatment-related side effects are fairly common.The balance of potential benefits and possible side effects is uncertain. This uncertainty leads the clinician to ask the next question.Need to discuss the individual benefits and risksof screening with all male patients 50-70years.
6Risk Of Prostate Cancer 2. The PSA Test-When to Refer to a Urologist. Risk of Prostate Cancer in Men with Normal DREPSA LevelsRisk Of Prostate Cancer1-1.9917%2-2.9924%3-3.9927%4-1029%10+45%
72. The PSA test When to refer to a urologist. Age Median PSA Normal Rangeng/ml ng/mlng/ml ng/mlng/ml ng/mlng/ml ng/ml
82. The PSA test- When to refer to a urologist 2. The PSA test- When to refer to a urologist. Free to Total (%) Does Help Specificity.
92. The PSA test- When to refer to a urologist 2. The PSA test- When to refer to a urologist. PSA Velocity is important to calculateMen with PSA below 4.0ng/mlPSA velocity > 10%/yr =30% risk CaPPSA velocity >0.4ng/ml/yr = 45% risk CaPPSA velocity >2.0ng/ml/yr = high risk of deathMore accurate with multiple measures over time.
102. The PSA test- When to refer to a urologist. Suggested Algorithm
123. Localised Prostate Cancer- Active Surveillance 99% 8year diseasespecific survivalAdvantages:Avoid treatment in 50% of menOnly treat men who need treatmentDisadvantagesAnxietyPossibility of “missing the window of opportunity”Patel et.al. J Urol. 2004;171(4):1520
133. Localised Prostate Cancer- Radical Prostatectomy Advantages:Good cure rateQuick recovery in young menSalvage XRTProstateNVBDisadvantagesPossible incontinencePossible impotenceRectum
143. Localised Prostate Cancer- Robotic or Laparoscopic Radical Prostatectomy AdvantagesLess blood loss1 day less hospital stayDisadvantagesUnable to palpate the cancer (Positive margin)Poorer continence and potencyLearning curveExpensive
153. Localised Prostate Cancer- Brachytherapy Advantages:Minor procedureDisadvantagesOnly for low riskUrinary symptomsRectal symptomsUnable to have surgery afterwardsUrethraRectum
163. Localised Prostate Cancer- External Beam Radiotherapy Advantages:Minor procedureDisadvantages7 weeks treatmentMay need hormonesUrinary symptomsRectal symptomsUnable to have surgery afterwards
173. Localised Prostate Cancer- HDR Brachytherapy Advantages:Good treatment of high risk diseaseDisadvantagesNeed hormones5 weeks EBRTUrinary symptomsRectal symptomsUnable to have surgery afterwards
183. Localised Prostate Cancer- HIFU Advantages:Minimally invasiveSimilar cure to XRTHigh continence and potencyRepeatable procedureDisadvantagesExpensiveExperimental
194. Androgen Deprivation Therapy How to Monitor These Men. FactorTreatmentOsteoporosisCa, Vit D, Exercise. Annual DEXA scanLipid profileRegular measurements, cholesterol lowering drugsWeight gainExerciseLoss of muscle massCognitive declineSocial support, Intellectual stimulationDepressionUnderstanding, Counselling, Exercise, Medication
20Summary Prostate Cancer Screening The PSA test Tell your patients all the Pros and Cons.The PSA testCriteria will continue changingDivide in to Definite, Possible and Watch categories.Localised Prostate CancerLots of new modalitiesAndrogen Deprivation TherapyMonitor their cardiac and bone health