Update on Prostate Cancer Current Controversies Lucas Jacomides, M.D.

Size: px
Start display at page:

Download "Update on Prostate Cancer Current Controversies Lucas Jacomides, M.D."

Transcription

1 Update on Prostate Cancer Current Controversies Lucas Jacomides, M.D. Assistant Professor of Surgery, Texas A&M Health Science Center College of Medicine Director of Urology, Scott & White-Round Rock

2 The proposed revision of the prostate cancer screening recommendations has generated considerable controversy

3 What all providers should know about PSA testing

4 Lifetime Probability of Developing Cancer, by Site, Men Site Risk All sites 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 17 Urinary bladder 1 in 28 Non-Hodgkin lymphoma 1 in 46 Melanoma 1 in 52 Kidney 1 in 64 Leukemia 1 in 67 Oral Cavity 1 in 73 Stomach 1 in 82 * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to All Sites exclude basal and squamous cell skin cancers and in situ cancers except bladder. Includes invasive and in situ cancer cases

5 2006 Estimated US Cancer Cases* Prostate ( K) 33% Men 720,280 Women 679,510 Breast 31% Lung & bronchus 13% Colon & rectum 10% Urinary bladder 6% Melanoma of skin 5% Non-Hodgkin 4% lymphoma Kidney 3% Oral cavity 3% Leukemia 3% Pancreas 2% Lung & bronchus 12% Colon & rectum 11% Uterine corpus 6% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Ovary 3% Urinary bladder 2% Pancreas 2% All Other Sites 18% All Other Sites 22% *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2006.

6 2006 Estimated US Cancer Deaths* Lung & bronchus 31% Colon & rectum 10% Prostate (26-33K) 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4% bile duct Esophagus 4% Non-Hodgkin 3% lymphoma Urinary bladder 3% Kidney 3% All other sites 23% Men 291,270 Women 273,560 Lung & bronchus 26% Breast 15% Colon & rectum 10% Pancreas 6% Ovary 6% Leukemia 4% Non-Hodgkin lymphoma 3% Uterine corpus 3% Multiple myeloma 2% Brain/ONS 2% All other sites 23% ONS=Other nervous system. Source: American Cancer Society, 2006.

7 2012 Estimates 241,740 American men diagnosed in % of Americans diagnosed have African heritage (41,095) 28,170 American men will die of prostate cancer in 2012

8 Change in the US Death Rates* by Cause, 1950 & 2007 Rate Per 100, Heart Diseases 45.1 Cerebrovascular Diseases 48.1 * Age-adjusted to 2000 US standard population. Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised Mortality Data: US Mortality Public Use Data Tape, 2003, NCHS, Centers for Disease Control and Prevention, Pneumonia/ Influenza Cancer

9 American Cancer Society Breaking News Feb fewer deaths

10 Cancer Screening Well designed clinical studies have demonstrated the mortality reduction through: Mammography and CBE for Breast Cancer Stool Blood Testing, Sigmoidoscopy and Colonoscopy for Colorectal Cancer Pap and Visual Screening for Cervical Cancer Low Dose Spiral CT for Lung Cancer

11 Death rate due to cancer from in men From Jemal, A. et al. CA Cancer J Clin 2007;57: Copyright 2007 American Cancer Society

12 Introduction of PSA

13 Cannot Completely Link PSA Screening To Mortality Declines PSA Screening Patterns Prostate Cancer Deaths?

14 Mortality Trends Suggest a Clear Role for PSA Screening No treatment Treatment Treatment and screening Cases diagnosed since 1975 ERSPC benefit

15 About Prostate Cancer Some prostate cancers are aggressive, advancing quickly and threaten the life of the patient. Some are indolent, slow growing and may never become life threatening in the man s lifetime. The only way to know if either exists is to be tested.

16 Before the PSA Era Prostate cancers were most commonly found following the onset of symptoms from advanced disease, or as a nodule found on DRE. Symptomatic tumors were of a higher grade, more advanced and often deadly.

17 Primary Treatment Changed Before and During the PSA Era Conservative management RP RT+ADT RT Data from SEER and CaPSURE

18 The most effective way to prevent advanced (metastatic) prostate cancer is to detect it early.

19 The goal of prostate cancer testing is not only to prevent mortality, but even more so to prevent the attendant morbidity that comes with metastatic prostate cancer. Urinary tract obstruction Fractures Significant bone pain

20 About the PSA Test The PSA test is the most widely available test to identify changes in the prostate. PSA is prostate-specific, not cancerspecific. Currently, there is no other widely available blood test for prostate cancer.

21 About the PSA Test When used appropriately, the PSA test provides clinicians with valuable information to aid in the diagnosis and treatment of prostate cancer.

22 Screening Decreases Prostate Cancer Mortality 11-Year Follow-Up of the 1988 Quebec Prospective Randomized Controlled Trial (Labrie et al Prostate 59:311, 2004)

23 SEER Database 75% reduction in metastases at time of diagnosis 42% reduction in prostate-cancer specific mortality over the most recent 20 years fewer men died of prostate cancer in 2007, compared to 1992 Models have suggested that 40-70% percent of this reduction is due to early detection.

24 PSA Screening Guidelines Annual PSA/DRE, beginning at age 50 Exceptions- begin at age 40 Well-informed men interested in early detection First-degree family members diagnosed before 65 African Americans Stop when less than 10-year life expectancy (USPSTF: age 75?)

25 So with all these positive reports, what s with all the recent controversy regarding PSA screening?

26 Critics of Prostate Cancer Screening There are cancers that do not need to be cured but can be cured. There are cancers that need to be cured but cannot be cured. (Our patients and friends who die). We do not know if we cure any disease that needs to be cured. ( Do we save lives? is an open question).

27 Prostate Cancer Incidence and Mortality ( ) Age-Adjusted Rate Per 100, Black Incidence 200 White Incidence 150 Black Mortality White Mortality

28 Critics of Prostate Cancer Screening Several studies have shown PSA screening finds a lot of cancer, but have failed to convincingly show that prostate cancer screening saves lives.

29 Most of the studies analyzed by the USPSTF demonstrate benefits from PSA testing.

30 Results from the PLCO and ERSPC Prostate Cancer Screening Trials were Published in NEJM, March 2009

31 PLCO 73,000 men aged 55 to 74 randomized to screening annually vs routine follow-up Began in 1993, ten U.S. Centers Median follow-up about ten years

32 Argument against PSA Screening: Results from NCI Randomized Prostate-Cancer Screening Trial (PLCO) (Andriole et al, N Engl J Med 2009;360:1310-9) Results: In the screening group, rates of compliance were 85% for PSA testing and 86% for digital rectal examination. Rates of screening in the control group increased from 40% in the first year to 52% in the sixth year for PSA testing and ranged from 41 to 46% for digital rectal examination. After 7 years of follow-up, the incidence of prostate cancer per 10,000 person-years was 116 (2820 cancers) in the screening group and 95 (2322 cancers) in the control group (rate ratio, 1.22; 95% confidence interval [CI], 1.16 to 1.29). The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group (rate ratio, 1.13; 95% CI, 0.75 to 1.70). The data at 10 years were 67% complete and consistent with these overall findings. Conclusions: After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.

33 PLCO Randomized Trial Outcomes: Prostate Cancer Deaths

34 ERSPC 162,000 men aged 50 to 69 randomized to screening vs routine follow-up (there was no standardized protocol) Began in 1991, seven countries Median follow-up about nine years For men 55 to 69, death rate 20% difference favoring screening P=.04 (minimally statistically significant) NNT 48 to 1 (overtreatment) Overall death rate not reported Treatment differences did exist

35

36 Over 14 years These men didn t die from CaP These men benefitted These men still died of CaP

37 If We Stick With the Observed Data ERSPC 2009 Publication 20% Reduction In Prostate Cancer Deaths Lives saved Deaths Without screening 1,000 men screened: 0.7 lives saved Significant Short-term Relative Benefit Insignificant Short-term Absolute Benefit

38 Issues with ERSPC Positive finding 20% risk reduction of prostate cancer death. Those in the screened arms had different treatment patterns than those in the control arms To prevent one prostate cancer death: - Screen 1410 men - Treat 48 men This is a pre-specified subset analysis. The actually trial was men 50 to 69 Is the study negative or positive?

39 Screening and Prostate-Cancer Mortality in a Randomized European Study (ERSPC) Schröder et al, N Engl J Med 2009;360: Background The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific antigen (PSA) testing on death rates from prostate cancer. Methods We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.

40 Screening and Prostate-Cancer Mortality in a Randomized European Study (ERSPC) Schröder et al, N Engl J Med 2009;360: Results In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P = 0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90). Conclusions PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN )

41 Relative Risk of Death for Screened vs Unscreened by Country

42 Surgical Treatment of Localized Cancer (Scandinavian Study, SPCG-4) years years years

43 Study Overview A total of 695 men with early prostate cancer were randomly assigned to radical prostatectomy or watchful waiting from

44 Surgical Treatment of Localized Cancer The Swedish prospectively randomized study of radical prostatectomy vs observation in a largely non screen detected cohort with T1b, T1c or T2 disease was the first study to show only a slight advantage to radical prostatectomy. 2% difference in mortality at 5 yrs follow-up 5.3% difference in mortality at 10 yrs follow-up Number needed to treat (NNT) was 20 treated to save one life

45 VA, NCI, AHRQ Cooperative Study #407: Prostate cancer Intervention Versus Observation Trial (PIVOT) PIVOT First randomized trial of radical prostatectomy versus observation for treatment of localized prostate cancer during PSA era

46 The PIVOT (Prostatectomy vs Observation Trial) Began in 1994, randomized to radical prostatectomy or supportive care Clinically localized PSA < 50 ng/ml Age <75 Mean PSA 10.2 ng/ml and Median 7.8 Wilt et al, AUA 2011

47 PIVOT 731 men (more than 9000 invited) 43% low risk 36% intermediate 21% high risk Median 12 years follow-up 354 of 731 dead (48.4%) Insignificant differences in all cause and prostate specific mortality A subset analysis showed slight benefit for high risk Wilt et al, AUA 2011

48 PIVOT Conclusions Compared to observation, radical prostatectomy produced small absolute differences (<3%) in all-cause and prostate cancer mortality that were not significant in men with clinically localized primarily PSA detected cancer. While a larger effect may occur in men with higher PSA or risk disease, surgery was not more effective than observation in men with low PSA or low risk prostate cancer.

49 Discussion Among men with localized prostate cancer detected in the early PSA era, prostate cancer mortality through 12 years was <10% Varied little by race, age, health status Varied considerably by tumor factors Low PSA, low stage and low risk disease: < 6% Higher PSA/risk disease: 10-20%

50 How does this fit into existing information? For most men with early stage PSA detected prostate cancer, surgery does not improve longterm overall or prostate cancer survival compared to observation and has harms The vast majority of men with PSA detected early stage prostate cancer do not die of their disease even if not treated with surgery or radiation Men treated with observation have similar longterm physical and mental health outcomes but fewer harms due to urinary, sexual and erectile dysfunction compared to men treated with surgery

51 What are the implications for prostate cancer care? PIVOT results support the role of observation in most men with PSA detected early stage prostate cancer. Men can be informed that observation provides similar survival, especially for those with low PSA, low risk disease, as well as mental and physical function compared to surgery and can avoid surgery related harms that include urinary and erectile dysfunction. Men can be informed that any survival benefit exists due to surgery may be limited to the minority of men with higher PSA and higher risk prostate cancer.

52

53 an independent panel of non-federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, OB/Gyns, nurses, and health behavior specialists). Did not include a prostate cancer expert (urologist or oncologist) in the development of recommendations for PSA testing.

54 USPSTF and the Affordable Care Act The ACA broadened the scope of the USPSTF, mandating that the group must assess, develop and update clinical preventive recommendations. The ACA requires that Medicare and qualified commercial plans cover those preventive services graded A and B by the USPSTF at 100 percent. Services with grades of C or D will require a co-pay.

55 In October, 2011, the USPSTF released a draft recommendation statement updating the 2008 Prostate Cancer Screening Recommendations. The new statement downgrades prostate cancer screening from an I to a D

56 The USPSTF organized their recommendation statement as follows: Importance - statement related to the disease burden and natural history Detection - performance of DRE, PSA, but also the evidence for distribution of aggressive vs. slow growing cancers, and overdiagnosis Benefits of detection and early intervention For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none Harms of detection and early intervention The USPSTF considered the magnitude of these screening-associated harms to be at least small The USPSTF considered the magnitude of these treatmentassociated harms to be at least moderate. USPSTF Assessment The USPSTF concludes that there is moderate certainty that the harms of PSA-based screening for prostate cancer outweigh the benefits.

57 Why not Grade C? Grade C would have meant that the USPSTF has concluded that there is at least moderate certainty that the overall net benefit of the service is small. The USPSTF felt they could not assign a grade C recommendation for PSA screening because it did not conclude that the benefits outweigh the harms.

58 The USPSTF Prostate Screening Statement The decision to initiate or continue PSA screening should reflect an explicit understanding of the possible benefits and harms and respect the patient s preferences. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by the patient.

59 The USPSTF Prostate Screening Statement Similarly, patients requesting PSA screening should be provided the opportunity to make an informed choice to be screened that reflects their values regarding specific benefits and harms. However, community- and employer-based screening should be discontinued.

60 The USPSTF Prostate Screening Statement The USPSTF has clarified in the Implementation section that a D recommendation does NOT preclude discussions between clinicians and patients to promote informed decision making that supports individual values and preferences. While the USPSTF discourages the use of screening tests for which the benefits do not outweigh the harms in the target population, it recognizes the common use of PSA screening in practice today and understands that some men will continue to request screening and some physicians will continue to offer it.

61 The USPSTF Prostate Screening Statement The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

62 In May 2012, following the release of the USPSTF s recommendations, the Obama Administration told the Associated Press that Medicare would continue to pay for the PSA test ( for now).

63 Organizations Recommending Against Routine Prostate Cancer Screening U.S. Preventive Services Taskforce Canadian Taskforce on the Periodic Health Examination American College of Preventive Medicine American College of Physicians

64 National Comprehensive Cancer Network There are advantages and disadvantages to having a PSA test, and there is no right answer about PSA testing for everyone. Each man should make an informed decision about whether the PSA test is right for him.

65 European Association of Urology Recommend for informed decision making within the physician-patient relationship. Recommends against mass screening. Men should obtain information on the risks and potential benefits of screening and make an individual decision European Urology 56(2), 2009

66 2009 Best Practice Statement on Prostate-Specific Antigen Early detection and risk assessment of prostate cancer should be offered to asymptomatic men 40 years of age or older who wish to be screened with an estimated life expectancy of more than 10 years. Men who wish to be screened for prostate cancer should have both a PSA test and a DRE. The decision to use PSA for the early detection of prostate cancer should be individualized. Patients should be informed of the known risks and the potential benefits.

67 2009 Best Practice Statement on Prostate-Specific Antigen Given the uncertainty that PSA testing results in more benefit than harm, a thoughtful and broad approach to PSA is critical. Patients need to be informed of the risks and benefits of testing before it is undertaken. The risks of overdetection and overtreatment should be included in this discussion.

68 2009 Best Practice Statement on Prostate-Specific Antigen The AUA strongly supports that men be INFORMED OF THE RISKS AND BENEFITS of prostate cancer screening before biopsy and the option of ACTIVE SURVEILLANCE IN LIEU OF IMMEDIATE TREATMENT FOR CERTAIN MEN newly diagnosed with prostate cancer.

69 The American Cancer Society 2010 Prostate Cancer Screening Guideline Men should have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening.

70 ACS Response to the Draft USPSTF Prostate Cancer Screening Recommendation Statement The ACS-PCAC agreed with the Task Force that there are significant limitations and risks associated with prostate cancer screening The ACS-PCAC concluded,..based on our interpretation of the current evidence related to benefits and harms, we recommend that the Task Force reconsider their interpretation of the data and upgrade prostate cancer screening to a C recommendation. Issuing a C recommendation would provide men with the opportunity to integrate their personal values into the screening decision.

71 ACS Response to the Draft USPSTF Prostate Cancer Screening Recommendation Statement The ACS Prostate Cancer Advisory Committee ACS-PCAC has submitted a comment on the draft screening recommendation to AHRQ, recommending that they upgrade the recommendation to a C grade. Specifically, the ACS-PCAC concluded that: the overdiagnosis associated with screening is significant the evidence from the European trials is more supportive of a possible benefit than has been interpreted by the Task Force. the estimate of the number needed to invite to prevent one prostate cancer death may be overstated.

72 Study Flaws of PLCO and ERSPC Contamination Selection Bias Length of followup

73 Contamination At least 52% concurrent PSA testing in PLCO control group and 40% or more had PSA testing before enrolling. Centers conducting PLCO were concurrently advertising mass PSA testing like Prostate Cancer Awareness Week! Is it then surprising that if you screen a lot and compare with screening a little bit more that you ll see no difference?

74 Contamination The likely consequence of the high rate of PSA testing in the control population is that contamination rates in the trials would be approximately 20% to 50%, and this appears to be having a major impact on the effective sample size, and the statistical power, of the studies.

75 Another Criticism of PLCO Screening Trial Prostate cancer detection rate was 12 % higher in the screening arm.

76 ERSPC Trial Selection Bias Influence of selection bias in countries where control group men were unaware they were in a study Were men in the control group with prostate cancer pre-randomization identified through the registries? Were men in the screened group with prostate cancer pre-randomization not allowed to opt out of the study? Differential availability of treatment in the screened vs. control group

77 Length of Followup Updated data demonstrates a 21 percent risk reduction in prostate cancer-related death (up to 29 percent after accounting for non compliance). Benefits observed primarily in men younger than 70 years Number of cancers that would need to be detected to prevent one death has dropped to 37.

78 Recent results from the Göteborg arm of the ERSPC 20,000 men born between Randomized 1:1, 10,000 in each arm PSA screening every 2 years, up to ~ age 70 vs. usual care Endpoint: Prostate cancer specific mortality

79

80 Göteborg Randomized Population-Based Prostate Cancer Screening Trial Population-based trial of 20,000 men ages Demonstrated a 41 percent decrease in advanced disease. Showed a 44 % relative risk reduction in prostate cancer mortality in men ages after a median of 14 years.

81

82 2011 Update (AUA National Meeting) Extending ERSPC to 11 years of followup Decreased NNS to 500 Decreased NNT to 18 Goteborg, Sweden Trial: 14 year followup NNS = 293 NNT = 12 44% reduction in prostate cancer-specific mortality (Mammography for breast cancer: NNT = 10)

83 Scandinavian Study (SPCG-4) years years years

84 Conclusions from 2002 (> 6 year followup) In this randomized trial, radical prostatectomy significantly reduced disease-specific mortality, but there was no significant difference between surgery and watchful waiting in terms of overall survival After a median follow-up of more than six years, more deaths due to prostate cancer had occurred in the watchful-waiting group, but overall survival in the two groups was essentially the same

85 2005: Argument for radical prostatectomy (> 8 year followup) Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial Men <65 years of age with prostate cancer diagnosed on the basis of obstructive urinary symptoms (rather than elevated prostate-specific antigen levels) and assigned to radical prostatectomy, as compared with watchful waiting, have improved survival.

86 Conclusions from 2011 (nearly 13 year followup) Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment (7x more likely to die of cancer). NNT=15 NNT = 7 for younger men

87 The argument for prostate cancer treatment Significant reduction in risk of prostate cancer death in Scandinavian RCT.

88

89 The only problem: compare it with the outcome seen with contemporary surveillance

90 49% fall in prostate cancer mortality. Continues to increase

91 We can t predict the future outcomes of our screening trials. However, there are very strong data to suggest that screening is currently preventing tens of thousands of deaths each year. I would not personally want to be in the position 5-6 years from now after PSA testing is stopped in the US, we learn that the ERSPC is showing what we ve seen in the US, and then I have to face the wife of a man who was denied a PSA test and died of the disease.

92 My take on all this Early on (<10 year followup), it seemingly doesn t matter what you do- you ll be fine After years, there may be significant differences in patient outcomes, depending on low or high-risk disease Key is early detection & risk-stratification Aggressively treat the bad ones Potentially observe the slow-growing ones

93 Who is at highest risk for prostate cancer & may derive greater benefit from screening? African-americans 1.6 x more likely to be diagnosed 2.5 x more likely to die Family history of prostate cancer Abnormal DRE PSA > 1 ng/ml at age 40

94 Variables associated with prostate cancer risk Digital rectal examination Age Race/ethnicity Family history Prior negative biopsy

95

96

97 PSA testing isn t a black and white issue.

98 Elevated PSA Scores A rise in PSA does NOT automatically: mean a man needs a BIOPSY. result in a CANCER diagnosis.

99 A prostate cancer DIAGNOSIS does not automatically mean a man needs immediate TREATMENT.

100 The current community standard is that active surveillance should be offered to appropriate patients. Low risk disease Limited life expectancy (<10 yrs) Patients who do not wish to pursue aggressive interventions

101 But the BOTTOM LINE is that a patient cannot make an informed decision about prostate cancer if he doesn t even know he has it.

102 Take-away Points Not all prostate cancers are life threatening and not all require active treatment immediately; however, we cannot do anything if we do not know a cancer exists. The decision to test for prostate cancer should be individualized to the patient (what is good for one man may not be best for another). Men should understand the pros and cons of testing (including next steps if cancer is suspected) and be allowed to make their own personal decision. Prostate cancer testing is necessary in order to provide patients the most options (including active surveillance) as early as possible in the progression of their disease.

103 Prostate cancer screening: yes or no? Mortality due to prostate cancer has and is decreasing Whether or not this is due to screening or aggressive disease findings is not clear Effective treatments for localized disease stages are part of the reasons While screening of entire populations may not show benefit, discuss with your patients the use of PSA in managing his prostate health

104 Questions in Prostate Cancer Medicine Risk factors including race Effectiveness of screening Effectiveness of treatments Localized disease Early metastatic disease Predicting biologic behavior of disease* *Perhaps most imperative

105 What steps urologists can take? 1. Biopsy only men with consequential cancer. 2. Consider surveillance in low-risk men. - 5-year DSS 99.6%; 10-year DSS > 97% My expectation is that it will become (or is) the standard of care.

106 What steps can we take after diagnosis 1. Consider surveillance in low-risk men. - 5-year DSS 99.6%; 10-year DSS > 97% My expectation is that it will become (or is) the standard of care. (For the NCCN, it is.) 2. Explore, especially in older men, expanding the definition of low-risk disease. 3. For high-risk disease, focus on multidisciplinary care.

107 We are approaching our ideal goal 1. Preferentially biopsy men with aggressive cancer. 2. In them, offer aggressive, multi-modal therapy. 3. In men in whom we detect low-grade, lowvolume disease, monitor it. These men may actually have a lower risk of death from prostate cancer than the man we re not currently offering a biopsy. 4. In men at risk of cancer, prevent it in the first place.

108 The Future of Prostate Cancer Better chemopreventative agents Better screening tests than PSA Better imaging to detect extra-prostatic disease More ablative treatment options Cyberknife? HIFU? Better options for metastatic disease Zytiga, Xgeva, Provenge, MDV3100

109 Conclusions Despite controversies surrounding prostate cancer prevention, detection, and treatment, fewer patients are dying of the disease in 2012 PSA remains the mainstay of prostate cancer detection (for now) Important to inform patients and involve them in decision-making regarding treatment options Need for risk-stratification

110 Thank you for coming! Questions & Answers

Cancer in Primary Care: Prostate Cancer Screening. How and How often? Should we and in which patients?

Cancer in Primary Care: Prostate Cancer Screening. How and How often? Should we and in which patients? Cancer in Primary Care: Prostate Cancer Screening How and How often? Should we and in which patients? PLCO trial (Prostate, Lung, Colorectal and Ovarian) Results In the screening group, rates of compliance

More information

Prostate Cancer Screening Recommendations from the US Preventive Services Task Force: Evidence and implementation to optimize health outcomes

Prostate Cancer Screening Recommendations from the US Preventive Services Task Force: Evidence and implementation to optimize health outcomes Prostate Cancer Screening Recommendations from the US Preventive Services Task Force: Evidence and implementation to optimize health outcomes Timothy J. Wilt, MD, MPH, MACP University of Minnesota and

More information

4/8/13. Pre-test Audience Response. Prostate Cancer 2012. Screening and Treatment of Prostate Cancer: The 2013 Perspective

4/8/13. Pre-test Audience Response. Prostate Cancer 2012. Screening and Treatment of Prostate Cancer: The 2013 Perspective Pre-test Audience Response Screening and Treatment of Prostate Cancer: The 2013 Perspective 1. I do not offer routine PSA screening, and the USPSTF D recommendation will not change my practice. 2. In light

More information

Screening for Prostate Cancer: Understanding the Evidence, Differences in Screening Guidelines, and Future Directions

Screening for Prostate Cancer: Understanding the Evidence, Differences in Screening Guidelines, and Future Directions Screening for Prostate Cancer: Understanding the Evidence, Differences in Screening Guidelines, and Future Directions American Council of Life Insurers Medical Section Annual Meeting February 24, 2013

More information

Prostate Cancer Screening

Prostate Cancer Screening Prostate Cancer Screening Bruce L. Houghton, MD Associate Professor of Medicine Division of General Medicine Department of Internal Medicine Creighton University School of Medicine http://en.wikipedia.org/wiki/image:prostatelead.jpg

More information

The PLCO Trial Not a comparison of Screening vs no Screening

The PLCO Trial Not a comparison of Screening vs no Screening PSA Screening: Science, Politics and Uncertainty David F. Penson, MD, MPH Hamilton and Howd Chair of Urologic Oncology Professor and Chair, Department of Urologic Surgery Director, Center for Surgical

More information

Prostate Cancer Screening in Taiwan: a must

Prostate Cancer Screening in Taiwan: a must Prostate Cancer Screening in Taiwan: a must 吳 俊 德 基 隆 長 庚 醫 院 台 灣 醫 學 會 105 th What is the PSA test? The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally

More information

Prostate Cancer Screening: What We ve Learned and Where we should go

Prostate Cancer Screening: What We ve Learned and Where we should go Prostate Cancer Screening: What We ve Learned and Where we should go Gerald L. Andriole, MD Robert K. Royce Distinguished Professor Chief of Urologic Surgery Siteman Cancer Center Washington University

More information

Prostate Cancer Screening: Are We There Yet? March 2010 Andrew M.D. Wolf, MD University of Virginia School of Medicine

Prostate Cancer Screening: Are We There Yet? March 2010 Andrew M.D. Wolf, MD University of Virginia School of Medicine Prostate Cancer Screening: Are We There Yet? March 2010 Andrew M.D. Wolf, MD University of Virginia School of Medicine Case #1 A 55 yo white man with well-controlled hypertension presents for his annual

More information

Cancer research in the Midland Region the prostate and bowel cancer projects

Cancer research in the Midland Region the prostate and bowel cancer projects Cancer research in the Midland Region the prostate and bowel cancer projects Ross Lawrenson Waikato Clinical School University of Auckland MoH/HRC Cancer Research agenda Lung cancer Palliative care Prostate

More information

Prostate cancer screening- pro and contra, lessons from the ERSPC study

Prostate cancer screening- pro and contra, lessons from the ERSPC study Prostate cancer screening- pro and contra, lessons from the ERSPC study Are we ready for a population-based screening program? Dr. Pim J.van Leeuwen Erasmus MC, Rotterdam, The Netherlands On behalf of

More information

PSA Screening for Prostate Cancer Information for Care Providers

PSA Screening for Prostate Cancer Information for Care Providers All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits

More information

Prostate-Specific Antigen (PSA) Based Population Screening for Prostate Cancer: OHTAC Recommendation

Prostate-Specific Antigen (PSA) Based Population Screening for Prostate Cancer: OHTAC Recommendation Prostate-Specific Antigen (PSA) Based Population Screening for Prostate Cancer: OHTAC Recommendation HEALTH QUALITY ONTARIO ONTARIO HEALTH TECHNOLOGY ADVISORY COMMITTEE RECOMMENDATION OHTAC recommends

More information

Prostate Cancer Early Detection: Update 2010

Prostate Cancer Early Detection: Update 2010 Prostate Cancer Early Detection: Update 2010 Prostate Cancer. Disease Burden The most common non-skin cancer, and the second leading cause of cancer death among U.S. men It is estimated that: 1 in 6 men

More information

Prostate Cancer Screening Clinical Practice Guideline. Approved by the National Guideline Directors November, 2013

Prostate Cancer Screening Clinical Practice Guideline. Approved by the National Guideline Directors November, 2013 Prostate Cancer Screening Clinical Practice Guideline This guideline is informational only. It is not intended or designed as a substitute for the reasonable exercise of independent clinical judgment by

More information

Early Detection of Prostate Cancer: Sunnybrook Health Sciences Centre Professor of Surgery University of Toronto

Early Detection of Prostate Cancer: Sunnybrook Health Sciences Centre Professor of Surgery University of Toronto Early Detection of Prostate Cancer: How to do it smart Laurence Klotz Sunnybrook Health Sciences Centre Professor of Surgery University of Toronto If screening was a pill: You are a 60 year old male and

More information

TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER

TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER TO SCREEN OR NOT TO SCREEN: THE PROSTATE CANCER DILEMMA Thomas J Stormont MD January 2012 http://www.youtube.com/watch?v=8jd 7bAHVp0A&feature=related related INTRODUCTION A government health panel (the

More information

Prostate Cancer Screening 18 th February 2016

Prostate Cancer Screening 18 th February 2016 Prostate Cancer Screening 18 th February 2016 Mira Keyes MD FRCPC Clinical Professor Radiation Oncology Department of Surgery UBC Head, BCCA prostate Brachytherapy Program Vancouver Cancer Centre, BC cancer

More information

The Prostate-Specific Antigen (PSA) Test: Questions and Answers

The Prostate-Specific Antigen (PSA) Test: Questions and Answers The Prostate-Specific Antigen (PSA) Test: Questions and Answers Key Points Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA

More information

PSA Testing for Prostate Cancer An information sheet for men considering a PSA Test

PSA Testing for Prostate Cancer An information sheet for men considering a PSA Test PSA Testing for Prostate Cancer An information sheet for men considering a PSA Test What is the aim of this leaflet? Prostate cancer is a serious condition. The PSA test, which can give an early indication

More information

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj.

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj. PSA Testing 101 Stanley H. Weiss, MD Professor, UMDNJ-New Jersey Medical School Director & PI, Essex County Cancer Coalition weiss@umdnj.edu September 23, 2010 Screening: 3 tests for PCa A good screening

More information

1. What is the prostate-specific antigen (PSA) test?

1. What is the prostate-specific antigen (PSA) test? 1. What is the prostate-specific antigen (PSA) test? Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood. The doctor

More information

The use of PSA testing in general practice. Ross Lawrenson Waikato Clinical Campus University of Auckland

The use of PSA testing in general practice. Ross Lawrenson Waikato Clinical Campus University of Auckland The use of PSA testing in general practice Ross Lawrenson Waikato Clinical Campus University of Auckland The Team Prostate cancer American Joint Committee on Cancer (AJCC) Staging System The AJCC staging

More information

Clinical Practice Guidelines

Clinical Practice Guidelines Clinical Practice Guidelines Prostate Cancer Screening CareMore Quality Management CareMore Health System adopts Clinical Practice Guidelines for the purpose of improving health care and reducing unnecessary

More information

Cancer in Northeastern Pennsylvania: Incidence and Mortality of Common Cancers

Cancer in Northeastern Pennsylvania: Incidence and Mortality of Common Cancers Cancer in Northeastern Pennsylvania: Incidence and Mortality of Common Cancers Samuel M. Lesko, MD, MPH Medical Director Karen Ryczak, RN Surveillance Coordinator November 2015 334 Jefferson Avenue, Scranton,

More information

PSA screening in asymptomatic men the debate continues www.bpac.org.nz keyword: psa

PSA screening in asymptomatic men the debate continues www.bpac.org.nz keyword: psa PSA screening in asymptomatic men the debate continues www.bpac.org.nz keyword: psa Key messages: PSA is present in the benign and malignant prostate There is currently no national screening programme

More information

Thomas A. Kollmorgen, M.D. Oregon Urology Institute

Thomas A. Kollmorgen, M.D. Oregon Urology Institute Thomas A. Kollmorgen, M.D. Oregon Urology Institute None 240,000 new diagnosis per year, and an estimated 28,100 deaths (2012) 2 nd leading cause of death from cancer in U.S.A. Approximately 1 in 6 men

More information

Prostate Cancer Screening: Phantom menace to society. Folusho Ogunfiditimi, DM, MPH, PA-C Vattikuti Urology Institute Henry Ford Health System

Prostate Cancer Screening: Phantom menace to society. Folusho Ogunfiditimi, DM, MPH, PA-C Vattikuti Urology Institute Henry Ford Health System Prostate Cancer Screening: Phantom menace to society Folusho Ogunfiditimi, DM, MPH, PA-C Vattikuti Urology Institute Henry Ford Health System Objectives USPTF Recommendations on PSA testing Justification

More information

Making sense of prostate cancer screening

Making sense of prostate cancer screening Making sense of prostate cancer screening Piotr Czaykowski MD MSc FRCPC Medical Oncology, CancerCare Manitoba University of Manitoba Disclosure of Potential for Conflict of Interest Name of presenter Name

More information

Breast cancer screening and prevention: Update from the USPSTF

Breast cancer screening and prevention: Update from the USPSTF Breast cancer screening and prevention: Update from the USPSTF Mark H. Ebell MD, MS Member, USPSTF College of Public Health The University of Georgia What we re going to do today Overview of the USPSTF

More information

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection

More information

Early Prostate Cancer: Questions and Answers. Key Points

Early Prostate Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Early Prostate Cancer:

More information

Controversites: Screening for Prostate Cancer in Older Adults

Controversites: Screening for Prostate Cancer in Older Adults Controversites: Screening for Prostate Cancer in Older Adults William Dale, MD, PhD University of Chicago Sections of Geriatrics & Palliative Medicine and Hematology/Oncology Director, Specialized Oncology

More information

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data The 2014 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2013 More than 70 percent of all newly diagnosed cancer patients are treated in the more than 1,500

More information

Modeling Drivers of Cost and Benefit for Policy Development in Cancer

Modeling Drivers of Cost and Benefit for Policy Development in Cancer Modeling Drivers of Cost and Benefit for Policy Development in Cancer Harms? Benefits? Costs? Ruth Etzioni Fred Hutchinson Cancer Research Center Seattle, Washington The USPSTF recommends against routine

More information

An Introduction to PROSTATE CANCER

An Introduction to PROSTATE CANCER An Introduction to PROSTATE CANCER Being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the

More information

Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward

Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward Update on Prostate Cancer: Screening, Diagnosis, and Treatment Making Sense of the Noise and Directions Forward 33 rd Annual Internal Medicine Update December 5, 2015 Ryan C. Hedgepeth, MD, MS Chief of

More information

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology Oncology Annual Report: Prostate Cancer 25 Update By: John Konefal, MD, Radiation Oncology Prostate cancer is the most common cancer in men, with 232,9 new cases projected to be diagnosed in the U.S. in

More information

NCCN Prostate Cancer Early Detection Guideline

NCCN Prostate Cancer Early Detection Guideline NCCN Prostate Cancer Early Detection Guideline Joan McClure Senior Vice President National Comprehensive Cancer Network African American Prostate Cancer Disparity Summit September 22, 2006 Washington,

More information

Prostate cancer. Christopher Eden. The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing.

Prostate cancer. Christopher Eden. The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing. Prostate cancer Christopher Eden The Royal Surrey County Hospital, Guildford & The Hampshire Clinic, Old Basing. Screening Screening men for PCa (prostate cancer) using PSA (Prostate Specific Antigen blood

More information

Number. Source: Vital Records, M CDPH

Number. Source: Vital Records, M CDPH Epidemiology of Cancer in Department of Public Health Revised April 212 Introduction The general public is very concerned about cancer in the community. Many residents believe that cancer rates are high

More information

November 25, 2015. Albert L Siu, MD, MSPH Chair, US Preventive Services Task Force 5600 Fishers Lane, Mail Stop 06E53A Rockville, MD 20857

November 25, 2015. Albert L Siu, MD, MSPH Chair, US Preventive Services Task Force 5600 Fishers Lane, Mail Stop 06E53A Rockville, MD 20857 November 25, 2015 Men's Health Network P. O. Box 75972 Washington, D.C. 20013 202-543-MHN-1 (6461) Fax 202-543-2727 Albert L Siu, MD, MSPH Chair, US Preventive Services Task Force 5600 Fishers Lane, Mail

More information

Prostate Cancer PSA Controversy and Emergence of Active Surveillance

Prostate Cancer PSA Controversy and Emergence of Active Surveillance Prostate Cancer PSA Controversy and Emergence of Active Surveillance Christopher J. Kane MD Professor of Surgery, Chief of Urology C Lowell and JoEllen Parsons Chair in Urology Disclosures NCI Kidney Cancer

More information

Clinical Practice Guidelines and Shared Decision Making for Prostate Cancer Screening

Clinical Practice Guidelines and Shared Decision Making for Prostate Cancer Screening Clinical Practice Guidelines and Shared Decision Making for Prostate Cancer Screening Dr. Roger Luckmann Associate Professor Family Medicine and Community Health UMass Medical School Disclosures I have

More information

PSA Screening and the USPSTF Understanding the Controversy

PSA Screening and the USPSTF Understanding the Controversy PSA Screening and the USPSTF Understanding the Controversy Peter C. Albertsen Division of Urology University of Connecticut Farmington, CT, USA USPSTF Final Report 1 Four Key Questions 1. Does PSA based

More information

Cancer Screening and Early Detection Guidelines

Cancer Screening and Early Detection Guidelines Cancer Screening and Early Detection Guidelines Guillermo Tortolero Luna, MD, PhD Director Cancer Control and Population Sciences Program University of Puerto Rico Comprehensive Cancer Center ASPPR Clinical

More information

Understanding Prostate Cancer

Understanding Prostate Cancer Understanding Prostate Cancer Guest Expert: Wm. Kevin, DO Associate Professor of Medical Oncology, Co-director of the Yale Cancer Center Prostate and Urologic Cancers Program www.wnpr.org www.yalecancercenter.org

More information

PSA Screening For Prostate Cancer: Yes Or No?

PSA Screening For Prostate Cancer: Yes Or No? PSA Screening For Prostate Cancer: Yes Or No? The United States Preventive Services Task Force issued a recommendation that healthy men should no longer receive PSA testing as part of routine cancer screening.

More information

PSA screening: Controversies and Guidelines

PSA screening: Controversies and Guidelines PSA screening: Controversies and Guidelines John Phillips, MD, FACS Department of Urology Urology Center of Westchester New York Medical College Historical PerspecGve Cancer of the prostate, although rare,

More information

Examining the Efficacy of Screening with Prostate- Specific Antigen Testing in Reducing Prostate Cancer Mortality

Examining the Efficacy of Screening with Prostate- Specific Antigen Testing in Reducing Prostate Cancer Mortality St. Catherine University SOPHIA Master of Arts in Nursing Theses Nursing 5-2012 Examining the Efficacy of Screening with Prostate- Specific Antigen Testing in Reducing Prostate Cancer Mortality Rachel

More information

Prostate Cancer Screening

Prostate Cancer Screening Prostate Cancer Screening The American Cancer Society and Congregational Health Ministry Team June Module To access this module via the Web, visit www.cancer.org and type in congregational health ministry

More information

DECISION AID TOOL PROSTATE CANCER SCREENING WITH PSA TESTING

DECISION AID TOOL PROSTATE CANCER SCREENING WITH PSA TESTING DECISION AID TOOL PROSTATE CANCER SCREENING WITH PSA TESTING This booklet is what is often called a decision aid. The goals of a decision aid are to help people better understand their medical choices

More information

Prostate cancer screening. It s YOUR decision!

Prostate cancer screening. It s YOUR decision! Prostate cancer screening It s YOUR decision! For many years now, a test has been available to screen for. The test is called the prostate-specific antigen blood test (or PSA test). It is used in combination

More information

Conflict of Interest Disclosures. Outcome of interest. USPSTF Grades. Deepu Gowda, MD, MPH. Screening for the following cancers:

Conflict of Interest Disclosures. Outcome of interest. USPSTF Grades. Deepu Gowda, MD, MPH. Screening for the following cancers: Cancer Screening: Cervical, Colon, Breast, and Prostate Screening Update Conflict of Interest Disclosures Deepu Gowda, MD, MPH Assistant Professor of Clinical Medicine Intensive Review of Internal Medicine

More information

The PSA Test for Prostate Cancer Screening:

The PSA Test for Prostate Cancer Screening: For more information, please contact your local VA Medical Center or Health Clinic. U.S. Department of Veterans Affairs Veterans Health Administration Patient Care Services Health Promotion and Disease

More information

An Introduction to PROSTATE CANCER

An Introduction to PROSTATE CANCER An Introduction to PROSTATE CANCER Being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the

More information

Screening for Prostate Cancer

Screening for Prostate Cancer Screening for Prostate Cancer Review against programme appraisal criteria for the UK National Screening Committee (UK NSC) Version 1: This document summarises the work of ScHARR 1 2 and places it against

More information

Prostate Cancer. Screening and Diagnosis. Screening. Pardeep Kumar Consultant Urological Surgeon

Prostate Cancer. Screening and Diagnosis. Screening. Pardeep Kumar Consultant Urological Surgeon The Royal Marsden Prostate Cancer Screening and Diagnosis Pardeep Kumar Consultant Urological Surgeon Prostate Cancer Screening and Diagnosis 08 02 2013 2 Screening 1 3 Q1.Lots of men have prostate cancer

More information

PSA: Screening for Prostate Cancer in Older Adults

PSA: Screening for Prostate Cancer in Older Adults PSA: Screening for Prostate Cancer in Older Adults William Dale, MD, PhD University of Chicago Sections of Geriatrics & Palliative Medicine and Hematology/Oncology Director, Specialized Oncology Care &

More information

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma.

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma. Prostate Cancer OVERVIEW Prostate cancer is the second most common cancer diagnosed among American men, accounting for nearly 200,000 new cancer cases in the United States each year. Greater than 65% of

More information

2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER

2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER 2010 SITE REPORT St. Joseph Hospital PROSTATE CANCER Humboldt County is located on the Redwood Coast of Northern California. U.S census data for 2010 reports county population at 134,623, an increase of

More information

A Gene Expression Test to Predict Prostate Cancer Aggressiveness. Use Prolaris as a guide in your medical and surgical management

A Gene Expression Test to Predict Prostate Cancer Aggressiveness. Use Prolaris as a guide in your medical and surgical management A Gene Expression Test to Predict Prostate Cancer Aggressiveness Use Prolaris as a guide in your medical and surgical management What is Prolaris? A direct molecular measure of prostate cancer tumor biology

More information

The PSA Controversy: Defining It, Discussing It, and Coping With It

The PSA Controversy: Defining It, Discussing It, and Coping With It The PSA Controversy: Defining It, Discussing It, and Coping With It 11 TH ANNUAL SYMPOSIUM ON MEN S HEALTH June 12, 2013 The PSA Controversy Defining It, Discussing It and Coping With It As of May 2012,

More information

Prostate Cancer Screening. A Decision Guide

Prostate Cancer Screening. A Decision Guide Prostate Cancer Screening A Decision Guide This booklet was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Is screening right for you?

More information

The Centers for Medicare & Medicaid Services (CMS) seeks stakeholder comments on the following clinical quality measure under development:

The Centers for Medicare & Medicaid Services (CMS) seeks stakeholder comments on the following clinical quality measure under development: The Centers for Medicare & Medicaid Services (CMS) seeks stakeholder comments on the following clinical quality measure under development: Title: Non-Recommended PSA-Based Screening Description: The percentage

More information

Screening for Prostate Cancer

Screening for Prostate Cancer Screening for Prostate Cancer It is now clear that screening for Prostate Cancer discovers the disease at an earlier and more curable stage. It is not yet clear whether this translates into reduced mortality

More information

Breast Cancer Screening Guideline July 1, 2010

Breast Cancer Screening Guideline July 1, 2010 Breast Cancer Screening Guideline July 1, 2010 Introduction These guidelines are informational only and are not intended or designed to substitute the reasonable exercise of independent clinical judgment

More information

The Burden of Cancer in American Adults

The Burden of Cancer in American Adults P F I Z E R F A C T S The Burden of Cancer in American Adults p p Front cover photo credit of lung x-ray: Swanson and Jett, Lung Cancer. Atlas of Cancer, Philadelphia: Current Medicine; 2003. Almost 11

More information

Cancers All Types. Cancer was the leading cause of death in Contra Costa. Table 1 Cancer deaths by race/ethnicity CHRONIC DISEASES

Cancers All Types. Cancer was the leading cause of death in Contra Costa. Table 1 Cancer deaths by race/ethnicity CHRONIC DISEASES Cancers All Types Cancer was the leading cause of death in Contra Costa. The most commonly diagnosed cancers in the county were prostate, breast, lung and colorectal cancer. Lung, colorectal, breast and

More information

Establishing a Cohort of African-American Men to Validate a Method for using Serial PSA Measures to Detect Aggressive Prostate Cancers

Establishing a Cohort of African-American Men to Validate a Method for using Serial PSA Measures to Detect Aggressive Prostate Cancers Establishing a Cohort of African-American Men to Validate a Method for using Serial PSA Measures to Detect Aggressive Prostate Cancers James R. Hebert, Sc.D., Cancer Prevention and Control Program, University

More information

Update on Prostate Cancer Screening Guidelines

Update on Prostate Cancer Screening Guidelines www.medscape.com Update on Prostate Cancer Screening Guidelines Christine Gonzalez, PharmD, CHHC US Pharmacist Abstract and Introduction Introduction In the United States, prostate cancer is the most common

More information

U.S. Preventive Services Task Force

U.S. Preventive Services Task Force U.S. Preventive Services Task Force Screening for Prostate Cancer: Recommendation Statement See related Putting Prevention into Practice on page 283. This summary is one in a series excerpted from the

More information

Official reprint from UpToDate www.uptodate.com 2013 UpToDate

Official reprint from UpToDate www.uptodate.com 2013 UpToDate Official reprint from UpToDate www.uptodate.com 2013 UpToDate The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Cancer Screening. Robert L. Robinson, MD, MS. Ambulatory Conference SIU School of Medicine Department of Internal Medicine.

Cancer Screening. Robert L. Robinson, MD, MS. Ambulatory Conference SIU School of Medicine Department of Internal Medicine. Cancer Screening Robert L. Robinson, MD, MS Ambulatory Conference SIU School of Medicine Department of Internal Medicine March 13, 2003 Why screen for cancer? Early diagnosis often has a favorable prognosis

More information

PROSTATE CANCER SCREENING PROSTATE CANCER SCREENING

PROSTATE CANCER SCREENING PROSTATE CANCER SCREENING 3:45 4:45pm Screening Guidelines for Men's Health SPEAKER Radha Rao, MD Presenter Disclosure Information The following relationships exist related to this presentation: Radha Rao, MD: No financial relationships

More information

Metastatic Cancer: Questions and Answers. Key Points

Metastatic Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Metastatic Cancer: Questions

More information

Prostate Cancer Screening. A Decision Guide for African Americans

Prostate Cancer Screening. A Decision Guide for African Americans Prostate Cancer Screening A Decision Guide for African Americans This booklet was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Published

More information

Cancer in North Carolina 2013 Report

Cancer in North Carolina 2013 Report Cancer in North Carolina 2013 Report January 2014 Updated by Central Cancer Registry Cancer in North Carolina Purpose Cancer is the leading cause of death in North Carolina even though cancer mortality

More information

Prostate-Specific Antigen Based Screening: Controversy and Guidelines

Prostate-Specific Antigen Based Screening: Controversy and Guidelines Prostate-Specific Antigen Based Screening: Controversy and Guidelines Eric H. Kim and Gerald L. Andriole Institutional Address: Washington University School of Medicine 4960 Children's Place Campus Box

More information

Cigna Medical Coverage Policy

Cigna Medical Coverage Policy Cigna Medical Coverage Policy Subject Prostate-Specific Antigen (PSA) Screening for Prostate Cancer Table of Contents Coverage Policy... 1 General Background... 2 Coding/Billing Information... 14 References...

More information

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening.

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening. CANCER SCREENING Dr. Tracy Sexton (updated July 2010) What is screening? Screening is the identification of asymptomatic disease or risk factors by history taking, physical examination, laboratory tests

More information

2012 Report on Cancer Statistics in Alberta

2012 Report on Cancer Statistics in Alberta 2012 Report on Cancer Statistics in Alberta Cancer in Alberta Surveillance & Reporting CancerControl AB February 2015 Acknowledgements This report was made possible through Surveillance & Reporting, Cancer

More information

PSA Test Provides the Early Prostate Cancer Detection That Has Saved the Life of Thousands of Men

PSA Test Provides the Early Prostate Cancer Detection That Has Saved the Life of Thousands of Men PSA Test Provides the Early Prostate Cancer Detection That Has Saved the Life of Thousands of Men Table of Contents 1. What the research shows on the effectiveness of the PSA test p. 2 2. PSA test guidelines

More information

Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer

Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer Guidance on Using Active Surveillance to Manage Men with Low-risk Prostate Cancer Citation: Prostate Cancer Working Group and Ministry of Health. 2015. Guidance on Using Active Surveillance to Manage Men

More information

Guidelines for Cancer Prevention, Early detection & Screening. Prostate Cancer

Guidelines for Cancer Prevention, Early detection & Screening. Prostate Cancer Guidelines for Cancer Prevention, Early detection & Screening Prostate Cancer Intervention Comments & Recommendations For primary prevention, it has been suggested that diets low in meat & other fatty

More information

Summary of Harms from Screening and Treatment for Prostate Cancer

Summary of Harms from Screening and Treatment for Prostate Cancer DRAFT: Advice from Dr John Childs MoH advisor Summary of Harms from Screening and Treatment for Prostate Cancer There are minimal risks directly attributable to PSA testing or transrectal ultrasound (TRUS)

More information

Should I have a prostate-specific antigen (PSA) test to screen for prostate cancer? PATIENT DECISION AID

Should I have a prostate-specific antigen (PSA) test to screen for prostate cancer? PATIENT DECISION AID Should I have a prostate-specific antigen (PSA) test to screen for prostate cancer? PATIENT DECISION AID The prostate-specific antigen (PSA) test is a blood test that is used to screen for prostate cancer.

More information

Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008

Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008 Investigating Community Cancer Concerns--Deer Park Community Advisory Council, 2008 David R. Risser, M.P.H., Ph.D. David.Risser@dshs.state.tx.us Epidemiologist Cancer Epidemiology and Surveillance Branch

More information

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer Copyright E 2007 Journal of Insurance Medicine J Insur Med 2007;39:242 250 MORTALITY Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer David Wesley, MD; Hugh

More information

Prostate Cancer: Screening Update Middlesex Hospital Cancer Center Comprehensive Prostate Cancer Program

Prostate Cancer: Screening Update Middlesex Hospital Cancer Center Comprehensive Prostate Cancer Program Prostate Cancer: Screening Update Middlesex Hospital Cancer Center Comprehensive Prostate Cancer Program Edward G. Myer, M.D. Middlesex Urology, P.C. October 15, 2015 Middlesex Hospital Cancer Center Comprehensive

More information

PROSTATE CANCER UPDATE. Presenter: Bruce W. Porterfield, MD, PhD

PROSTATE CANCER UPDATE. Presenter: Bruce W. Porterfield, MD, PhD PROSTATE CANCER UPDATE DISCLOSURES I, BRUCE WAYNE PORTERFIELD HAVE NOTHING TO DISCLOSE. OBJECTIVES Epidemiology Early detection and screening Review of clinical disease states Treatment options by disease

More information

Prostate Cancer Screening Guideline

Prostate Cancer Screening Guideline Prostate Cancer Screening Guideline Contents Prevention 2 Screening Recommendations 2 Shared Decision Making 2 Test Recommendations 3 Follow-up/Referral 3 Treatment Overview 4 Evidence Summary 4 References

More information

Focus on Prostate Cancer

Focus on Prostate Cancer 2010 A N N U A L R E P O RT Edwards Cancer Center Focus on Prostate Cancer Union Welcome from the President Letter from the Chairman Carolinas Medical Center-Union and Edwards Cancer Center continue our

More information

Prostate Cancer in Older Men

Prostate Cancer in Older Men CHAPTER 2 Prostate Cancer in Older Men rostate cancer is a major health problem in the United States. In 1995, 244,000 new cases (up 44,000 from 1994) of prostate cancer and 40,400 deaths (up 2,400 from

More information

News Report No More PSA Testing? What Are They Thinking?

News Report No More PSA Testing? What Are They Thinking? News Report No More PSA Testing? What Are They Thinking? By Bob Marckini This was going to be a short article in this month s BOB Tales newsletter, but based on the considerable follow up media coverage

More information

HEALTH NEWS PROSTATE CANCER THE PROSTATE

HEALTH NEWS PROSTATE CANCER THE PROSTATE HEALTH NEWS PROSTATE CANCER THE PROSTATE Prostate comes from the Greek meaning to stand in front of ; this is very different than prostrate which means to lie down flat. The prostate is a walnut-sized

More information

Science Highlights. To PSA or not to PSA: That is the Question.

Science Highlights. To PSA or not to PSA: That is the Question. Science Highlights June 2012 by Ann A. Kiessling, PhD at the To PSA or not to PSA: That is the Question. The current raucous debate over the commonly used PSA blood test to screen for prostate cancer,

More information

Focus on PSA Screening for Prostate Cancer Vol. 28 Supplement, February 2012. Prostate Cancer: Should We Be Screening?

Focus on PSA Screening for Prostate Cancer Vol. 28 Supplement, February 2012. Prostate Cancer: Should We Be Screening? Focus on PSA Screening for Prostate Cancer Vol. 28 Supplement, February 2012 Prostate Cancer: Should We Be Screening? INSIDE THIS ISSUE 2 Why the Controversy? 3 Active Surveillance 4 The Radical Prostatectomy

More information

Prostate Cancer 2014

Prostate Cancer 2014 Prostate Cancer 2014 Eric A. Klein, M.D. Chairman Glickman Urological and Kidney Institute Professor of Surgery Cleveland Clinic Lerner College of Medicine Incidence rates, US Men Mortality Rates, US Men

More information