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Prostate Cancer What a GP Needs to Know Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Sydney Adventist Hospital Westmead Public and.

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Presentation on theme: "Prostate Cancer What a GP Needs to Know Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Sydney Adventist Hospital Westmead Public and."— Presentation transcript:

1 Prostate Cancer What a GP Needs to Know Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Sydney Adventist Hospital Westmead Public and Private Hospital Senior Lecturer, University of Sydney

2 Prostate Cancer What a GP Needs to Know Prostate Cancer Screening –What you need to tell your patients. The PSA test –When to refer to a urologist. Localised Prostate Cancer –What are the newest modalities? Androgen Deprivation Therapy –How to monitor these men.

3 1. Prostate Cancer Screening What you need to tell your patients. Mr J.B. 57 year old. Mild LUTS Hypertension Asks his G.P. whether he needs a test for prostate cancer? What should the G.P discuss with him?

4 1. Prostate Cancer Screening What you need to tell your patients. PSA –Blood test –Can detect early Cancer Digital Rectal Exam –Important –15% of cancers have “normal” PSA but abnormal DRE.

5 Potential Benefits 1. Prostate Cancer Screening What you need to tell your patients. Potential Harms Need to discuss the individual benefits and risks of screening with all male patients 50-70years. PSA screening detects cancers earlier. Treating early CaP improves survival. Negative results reduce anxiety Test is easy to administer False positives are common. Indolent cancers are treated inadvertently

6 2. The PSA Test-When to Refer to a Urologist. Risk of Prostate Cancer in Men with Normal DRE 2. The PSA Test-When to Refer to a Urologist. Risk of Prostate Cancer in Men with Normal DRE PSA Levels Risk Of Prostate Cancer % % % % %

7 2. The PSA test When to refer to a urologist. AgeMedian PSANormal Range ng/ml0-2.5ng/ml ng/ml0-3.5ng/ml ng/ml0-4.5ng/ml ng/ml0-6.5ng/ml

8 2. 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.

9 2. The PSA test- When to refer to a urologist. PSA Velocity is important to calculate Men with PSA below 4.0ng/ml –PSA velocity > 10%/yr =30% risk CaP –PSA velocity >0.4ng/ml/yr = 45% risk CaP –PSA velocity >2.0ng/ml/yr = high risk of death –More accurate with multiple measures over time.

10 2. The PSA test- When to refer to a urologist. Suggested Algorithm

11 3. Localised Prostate Cancer- Options of Treatment 1.Active Surveillance 2.Radical Prostatectomy 3.Seed Brachytherapy 4.External Beam Radiotherapy +/- hormone deprivation. 5.HDR Brachytherapy 6.HIFU (High Intensity Focused Ultrasound) 7.Watchful Waiting

12 3. Localised Prostate Cancer- Active Surveillance Advantages: Avoid treatment in 50% of men Only treat men who need treatment Disadvantages Anxiety Possibility of “missing the window of opportunity” Patel et.al. J Urol. 2004;171(4): % 8year disease specific survival

13 3. Localised Prostate Cancer- Radical Prostatectomy Advantages: Good cure rate Quick recovery in young men Salvage XRT Disadvantages Possible incontinence Possible impotence Prostate Rectum NVB

14 3. Localised Prostate Cancer- Robotic or Laparoscopic Radical Prostatectomy Advantages Less blood loss 1 day less hospital stay Disadvantages Unable to palpate the cancer (Positive margin) Poorer continence and potency Learning curve Expensive

15 3. Localised Prostate Cancer- Brachytherapy Advantages: Minor procedure Disadvantages Only for low risk Urinary symptoms Rectal symptoms Unable to have surgery afterwards Rectum Prostate Urethra

16 3. Localised Prostate Cancer- External Beam Radiotherapy Advantages: Minor procedure Disadvantages 7 weeks treatment May need hormones Urinary symptoms Rectal symptoms Unable to have surgery afterwards

17 3. Localised Prostate Cancer- HDR Brachytherapy Advantages: Good treatment of high risk disease Disadvantages Need hormones 5 weeks EBRT Urinary symptoms Rectal symptoms Unable to have surgery afterwards

18 3. Localised Prostate Cancer- HIFU Advantages: Minimally invasive Similar cure to XRT High continence and potency Repeatable procedure Disadvantages Expensive Experimental

19 4. Androgen Deprivation Therapy How to Monitor These Men. 4. Androgen Deprivation Therapy How to Monitor These Men. FactorTreatment OsteoporosisCa, Vit D, Exercise. Annual DEXA scan Lipid profileRegular measurements, cholesterol lowering drugs Weight gainExercise Loss of muscle mass Exercise Cognitive decline Social support, Intellectual stimulation DepressionUnderstanding, Counselling, Exercise, Medication

20 Summary Prostate Cancer Screening –Tell your patients all the Pros and Cons. The PSA test –Criteria will continue changing –Divide in to Definite, Possible and Watch categories. Localised Prostate Cancer –Lots of new modalities Androgen Deprivation Therapy –Monitor their cardiac and bone health


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