1. PSA Testing Importance of Multiple Markers Ian Thompson MD Department of Urology University of Texas HSC San Antonio, TX

2. Thompson IM et al. N Engl J Med 2004;350:2239-46

4. Population Screening with PSA True Outcomes 4.0+ PSA 4+ 7.6% Positive biopsy 25% High grade 19% Screen 10,000 Men PSA 4+ 760 Cancer 190 High grade 36 PSA <4 9240 Cancer 1386 High grade 208 Normal PSA 92.4% Positive biopsy 15% High grade 15% <4.0 PSA SEER, PCAW, Prostate Cancer Prevention Trial Data

5. Pause for a moment You read in a throwaway magazine about the benefits of a bASA daily. You worry about GI upset. You ask your own PCP, should I take a bASA? How do they assess your risk?

6. 10-year risk of coronary artery disease

7. So why do we use just PSA? DRE Age Race/ethnicity Family history Prior negative biopsy PSA velocity

14. Let’s just take some examples Point in play: Dichotomy of DRE as a solitary measure of risk 55 yo WM, -FHx, DRE+, no prior bx, PSA 0.3 – recommendation? – Biopsy, right? 68 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4 – recommendation? – No biopsy, right?

15. This example (DRE dichotomy) 55 yo WM, -FHx, DRE+, no prior bx, PSA 0.3 68 yo AAM, +FHx, DRE-, no prior bx, PSA 2.4 What are these men’s risk of disease? 1 st man – Cancer=13% High grade cancer=1% 2 nd man – Cancer=31%. High grade – 11%. Doesn’t make any sense, correct?

19. The Next Step Adding Body Mass Index Adding Population ‘Norms’ Adding pro-PSA