Prostrate Anatomy
Prostrate Cancer- Screening
- Reference: EARLY DETECTION OF PROSTATE CANCER: AUA GUIDELINE
- The strongest evidence of benefit for PSA screening for early diagnosis of prostate cancer is in the age group 55 to 69 years since this is the group studied in randomized trials. Thus, targeting of men age 55 to 69 years, after a risk benefit discussion, represents one approach to screening that is based on best evidence
- Strong evidence for a lack of treatment benefit for men in the age group 74+, especially those with a life expectancy below 10-15 years
- Studies
- SRSPC
- PLCO
- No survival benefit, 25 % of screening patients had LUTS / BPH
- PIVOT
- New upcoming studies
- Protect T Study
- Diagnosed of Prostrate cancer by screeing in 1999-2001
- Usual care: US NHS
- CAP study
- 5 ARIS : No decrease by 50 % then, strongly suspect for prostrate cancer. Do a pretreatment PSA check up in these patients.
- Harm associated with PSA screening
- Bleeding
- Infection
- Incontinence
- ED
- Fasle positive rates
- Over-diagnosis
- Death
- Various organization recommendation
- USPTF: Against screening
- They are reevaluating it and results will come back in next 12 months
- ACP: 50-69 Discuss the risk and benefits, and documents
- < 50 : No
- > 60 NO
- < 10 yrs survival : No
- AUA
- <40 NO
- 40-54 : No
- 55-59: Discuss
- For those screened every 2 yrs
- >70 NO
 
- Once Diagnosed:
- Define the Risk and the Life expectancy to decide on the work up and treatment approach
- Risk Categories
- Low Risk
- Very-low Risk(Gleason score of 6 or less on biopsy and a serum PSA <10 ng/mL; <3 positive cores, no core ≥50 percent involved, serum PSA <10 ng/mL,and PSA density <0.15)
- Low Risk (limited disease in one lobe of the prostate gland, a serum PSA <10 ng/mL, and the Gleason score ≤6)
- Intermediate Risk (a serum PSA between 10 and 20 ng/mL or a biopsy Gleason score 7)
- High Risk (Stage T3 and T4, Gleason score 8-10, or s PSA level > 20 ng/mL)
- High-risk, clinically localized prostate cancer
- Very high risk prostate cancer
- Lymph node involvement
- Disseminated disease
- Life Expectancy (that we look for different stage is different)
- Low Risk: <10 yr, 10-20, >20 yr
- Intermediate risk: <10 yr, >10 yr
- High Risk: <5 yr, >5 yr
- High Risk Disease usually has a lethal course if left untreated (28% 5 yr survival in T4)
https://mksap17.acponline.org/app/tables
- 4 Stages
- T1: Clinically Inapparent Tumor
- T2: Tumor confined to prostrate
- T3: Tumor extends through prostrate capsule and may invade the seminal vesicles
- T4: Tumor fixed or invades adjacent structures
- Treatment
- 5 treatment options exists for patients with newly diagnosed prostrate cancer
- Observation or Active Surveillance
- Radiation
- Prostatectomy
- Androgen deprivation therapy (ADT; hormonal therapy)
- Usually ADT is done for 8 months followed by Radiation therapy
- Screen for osteopenia, may need bisphosphonates
- Ca and Vit D are given
- Chemotherapy (if metastatic disease or hormone resistance)
- docetaxel plus prednisone is usually used
- Table 42. Initial Treatment of Prostate Cancer MKSAP 16
Testicular Cancer Testicular Cancer — Discoveries and Updates NEJM 2014
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