The document summarizes the PI-RADS (Prostate Imaging Reporting and Data System) guidelines for prostate imaging and reporting. It describes the goal of PI-RADS to standardize acquisition, interpretation, and reporting of prostate imaging globally. It also reviews techniques for prostate cancer screening and diagnosis including digital rectal exam, prostate-specific antigen testing, transrectal ultrasound biopsy, and multiparametric magnetic resonance imaging, and discusses the Gleason grading system for evaluating prostate cancer specimens.
This document discusses the use of the Prolaris test in decision making for prostate cancer treatment. It describes several case studies where Prolaris provided more precise risk stratification compared to standard tests like Gleason score and CAPRA. Prolaris separated patients into more meaningful low and high risk groups, changing treatment decisions in about 2/3 of cases. The document argues Prolaris adds value by improving risk prediction compared to existing tools. It suggests Prolaris could be incorporated into optimal prostate cancer care pathways to better guide active surveillance versus immediate treatment.
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Screening for Prostate cancer has had many different opinions and much research has been conducted in the last 20 years. In this presentation we will discuss the current guidelines for proper screening and gain more insight into men’s health.
Screening for prostate cancer using PSA has several limitations. It It is an organ specific marker, however, pathology specificity is low (elevated in all, prostatitis, prostatomegaly, prostate cancer, prostate manipulation). Attempts have been made to improve specificity while retaining its sensitivity, e.g. PSA density, PSA % free, PSA velocity, prostate health index (which takes into account p2PSA as well).
after diagnosis of prostate cancer, PSA doubling time is used for assessment of indication of treatment for patients on active surveillance as well as that for indication of salvage treatment for patients with biochemical recurrence after initial treatment.
This document discusses the use of the Prolaris test in decision making for prostate cancer treatment. It describes several case studies where Prolaris provided more precise risk stratification compared to standard tests like Gleason score and CAPRA. Prolaris separated patients into more meaningful low and high risk groups, changing treatment decisions in about 2/3 of cases. The document argues Prolaris adds value by improving risk prediction compared to existing tools. It suggests Prolaris could be incorporated into optimal prostate cancer care pathways to better guide active surveillance versus immediate treatment.
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Screening for Prostate cancer has had many different opinions and much research has been conducted in the last 20 years. In this presentation we will discuss the current guidelines for proper screening and gain more insight into men’s health.
Screening for prostate cancer using PSA has several limitations. It It is an organ specific marker, however, pathology specificity is low (elevated in all, prostatitis, prostatomegaly, prostate cancer, prostate manipulation). Attempts have been made to improve specificity while retaining its sensitivity, e.g. PSA density, PSA % free, PSA velocity, prostate health index (which takes into account p2PSA as well).
after diagnosis of prostate cancer, PSA doubling time is used for assessment of indication of treatment for patients on active surveillance as well as that for indication of salvage treatment for patients with biochemical recurrence after initial treatment.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
1) The accuracy of the PSA test for detecting prostate cancer depends on the age of the patient and the prevalence of prostate cancer, which increases significantly with age.
2) For patients under 70 years old, the PSA test has very low accuracy, ranging from near 0% to 22% accuracy, which could lead to many unnecessary invasive biopsies.
3) The U.S. Preventive Services Task Force recommends against PSA-based prostate cancer screening for men 75 and older, and makes no recommendation for men under 75 due to inadequate evidence that screening improves health outcomes.
The document provides information on developing clinical guidelines for prostate cancer screening using PSA testing. It includes requirements for effective screening programs, characteristics of the PSA test, results from two large randomized controlled trials (PLCO and ERSPC) on PSA screening, and considerations for formulating a screening guideline. A third summary discusses estimates of lead time and overdiagnosis from prostate cancer screening from three mathematical models, with lead times ranging from 5-7 years and overdiagnosis estimated at 23-42% of screen-detected cancers.
This document discusses the approach to localized prostate cancer. It begins by outlining the various treatment options available after diagnosis. It then defines localized prostate cancer and discusses how widespread PSA screening has led to earlier detection and improved survival rates. Risk stratification methods like the D'Amico and EAU systems are introduced. Counseling patients involves shared decision making considering cancer severity, life expectancy, expected functional outcomes, and risks. Treatment methods like active surveillance, surgery, radiation, and androgen deprivation are covered at a high level. Follow up for active surveillance involves periodic PSA, DRE, and biopsy to monitor for cancer progression.
Biomarkers of prostate cancer with stagingroysudip900
This document discusses biomarkers and recent grading systems for prostate carcinoma. It begins by introducing prostate cancer as the second most commonly diagnosed malignancy in men. It then discusses several biomarkers used for diagnosis and prognosis, including prostate-specific antigen (PSA) and related factors like PSA density and kinetics. Newer biomarkers discussed include PCA3, TMPRSS2-ERG gene fusion, and circulating tumor cells. The document also covers recent grading systems like the Gleason score and 2014 ISUP grade groups which stratify prognosis.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
This document provides an overview and guidelines for the diagnosis and management of prostate cancer from the National Comprehensive Cancer Network. It discusses the classification, staging, diagnostic evaluation through PSA tests, biopsy and imaging. It covers management options including active surveillance, radical prostatectomy and their pre-operative preparation. Post-operative follow up, quality of life outcomes and recurrence are also reviewed based on latest evidence and guidelines.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
The 4Kscore® blood test for risk of aggressive prostate cancerOPKO Labs
The 4Kscore blood test uses PSA, free PSA, intact PSA and hK2 levels, along with other factors, to predict an individual's risk of having aggressive prostate cancer. It was developed over 10 years working with over 22,000 men. A US study of over 1,000 men validated that the 4Kscore accurately identified those with aggressive prostate cancer detected on biopsy. The test has greater accuracy than PSA alone and can help guide decisions on whether a biopsy is needed. Its risk assessment is included in NCCN guidelines for early prostate cancer detection.
1. The document discusses whether prostate cancer screening should be recommended for elderly men over age 65 given the high prevalence of prostate cancer but also the slow growing nature in many cases and short life expectancy.
2. While screening can detect cancer early, it also risks overdiagnosing biologically unimportant cancers and subjects men to potential harms of treatment without clear benefits due to their age.
3. Guidelines in the US have differing recommendations regarding screening older men, reflecting the ongoing debate around the balance of risks and benefits in this population.
1. The document discusses the debate around prostate cancer screening in elderly men over age 65, with arguments on both sides.
2. Screening may detect cancers early that would not have progressed or caused harm in a man's lifetime given his life expectancy. However, screening also risks overdiagnosis and overtreatment of biologically unimportant cancers.
3. Guidelines in the US do not recommend routine screening for low-risk, elderly patients due to the scientific uncertainties around the balance of benefits and harms. Patient-clinician discussion is important to make informed, individual decisions.
The PSA test measures levels of prostate-specific antigen in the blood to screen for prostate cancer. High PSA levels could indicate prostate cancer but can also be caused by other prostate conditions. There is conflicting advice about PSA testing and whether a man should get tested depends on discussing risks and benefits with their doctor. In addition to a PSA test, doctors may perform a digital rectal exam to check the prostate for abnormalities. The US Preventive Services Task Force currently recommends against PSA screening because many men are harmed by overtreatment while few benefit, as better tests and treatments are still needed.
1) A study called PIVOT compared radical prostatectomy to observation in men with early stage prostate cancer over 12 years and found no significant difference in mortality. An extended follow up of PIVOT over 20 years still found no significant difference in all-cause or prostate cancer mortality between the two groups.
2) Absolute differences in mortality risk increased slightly over time but remained small, with less than a 6 percentage point difference in all-cause mortality and 4 percentage points for prostate cancer mortality. Surgery was associated with less disease progression but most progression was asymptomatic.
3) The study concludes that radical prostatectomy was not associated with significantly lower mortality compared to observation over 20 years. Death from prostate cancer was very uncommon
The document summarizes the key findings and implications of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The trial found that for men with low-risk prostate cancer, radical prostatectomy did not provide a benefit over observation in reducing mortality rates. This suggests that observation may be a reasonable option for some low-risk prostate cancer patients over age 60. However, the trial also implied that radical prostatectomy may provide survival benefits for those with higher-risk disease. The document discusses several limitations of the PIVOT trial and ongoing debates around the management and treatment of localized prostate cancer.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Prostate cancer is a relatively common cancer in men over 60. If not treated early, it can spread from the prostate to bones and lymph nodes. Symptoms may include bone pain, urinary problems, erectile dysfunction, pelvic discomfort, and weak urine stream. Services offered to treat prostate cancer include radiation therapy, hormonal treatment, surgical removal of the testicles or prostate gland, and transurethral resection of the prostate. Men experiencing symptoms should book an appointment with a urologist.
This document summarizes a study analyzing media coverage of updated prostate cancer screening guidelines from the USPSTF and AUA. The study found that:
1) 92 news articles were analyzed from 2011-2013 covering the preliminary 2011 USPSTF guidelines, final 2012 guidelines, and 2013 AUA guidelines.
2) Articles frequently emphasized potential downsides of screening and inaccurately summarized guidelines/evidence.
3) Coverage of the USPSTF announcements was more extensive than the AUA guidelines.
4) Urologists were commonly interviewed but articles also cited costs and urologists' financial interests in screening.
5) The study provides insight into how media shapes views of
This case study discusses treatment options for a 45-year-old man with low risk prostate cancer based on an elevated PSA. Screening is recommended due to his family history of prostate cancer in his father. Further testing reveals a small, low grade tumor. He is a candidate for active surveillance, brachytherapy, or radical prostatectomy. Active surveillance is preferred given his age and low risk profile to avoid overtreatment. Brachytherapy is also an option and has advantages over external beam radiation in reducing dose to surrounding organs. Close monitoring is needed as most low risk prostate cancer patients will not require immediate treatment.
Prostate cancer screening and early detection is an ongoing area of research and debate. While screening can detect prostate cancer earlier when it may be more treatable, it also leads to overdiagnosis and overtreatment. Several large clinical trials have had conflicting results on the benefits of prostate cancer screening. Guidelines from organizations also vary in their recommendations for screening. New biomarkers and imaging techniques are being studied to improve screening specificity and reduce unnecessary biopsies and treatment. Overall, the effectiveness of prostate cancer screening remains uncertain, and any decision to be screened requires informed discussion of risks and benefits.
This seminar discussed screening for carcinoma of the prostate. It was chaired by Prof. C. S. Ratkal and co-chaired by Dr. M. Shivalingaiah. Dr. Prakash H. S. presented on various screening modalities including digital rectal examination (DRE), prostate-specific antigen (PSA) testing, prostate biopsy, and imaging. PSA testing combined with DRE is the most useful first-line screening approach. While screening can detect early-stage cancers, it also risks overdiagnosis and overtreatment of indolent tumors. The benefits and limitations of prostate cancer screening continue to be debated.
Mon 8-00 Prostate Cancer Screening in the Post-USPSTF Era_0.pptxRonitEnterprises
This document discusses prostate cancer screening and recommendations. It begins with a case presentation of a 54-year-old man before discussing the US Preventive Services Task Force recommendations against PSA screening. It then reviews the goals of cancer screening, basics of PSA testing and prostate cancer, impact of the Task Force, and ways to improve screening through risk stratification using newer biomarkers, imaging, and genetic profiling to avoid overdiagnosis while identifying high-risk cancers.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
1) The accuracy of the PSA test for detecting prostate cancer depends on the age of the patient and the prevalence of prostate cancer, which increases significantly with age.
2) For patients under 70 years old, the PSA test has very low accuracy, ranging from near 0% to 22% accuracy, which could lead to many unnecessary invasive biopsies.
3) The U.S. Preventive Services Task Force recommends against PSA-based prostate cancer screening for men 75 and older, and makes no recommendation for men under 75 due to inadequate evidence that screening improves health outcomes.
The document provides information on developing clinical guidelines for prostate cancer screening using PSA testing. It includes requirements for effective screening programs, characteristics of the PSA test, results from two large randomized controlled trials (PLCO and ERSPC) on PSA screening, and considerations for formulating a screening guideline. A third summary discusses estimates of lead time and overdiagnosis from prostate cancer screening from three mathematical models, with lead times ranging from 5-7 years and overdiagnosis estimated at 23-42% of screen-detected cancers.
This document discusses the approach to localized prostate cancer. It begins by outlining the various treatment options available after diagnosis. It then defines localized prostate cancer and discusses how widespread PSA screening has led to earlier detection and improved survival rates. Risk stratification methods like the D'Amico and EAU systems are introduced. Counseling patients involves shared decision making considering cancer severity, life expectancy, expected functional outcomes, and risks. Treatment methods like active surveillance, surgery, radiation, and androgen deprivation are covered at a high level. Follow up for active surveillance involves periodic PSA, DRE, and biopsy to monitor for cancer progression.
Biomarkers of prostate cancer with stagingroysudip900
This document discusses biomarkers and recent grading systems for prostate carcinoma. It begins by introducing prostate cancer as the second most commonly diagnosed malignancy in men. It then discusses several biomarkers used for diagnosis and prognosis, including prostate-specific antigen (PSA) and related factors like PSA density and kinetics. Newer biomarkers discussed include PCA3, TMPRSS2-ERG gene fusion, and circulating tumor cells. The document also covers recent grading systems like the Gleason score and 2014 ISUP grade groups which stratify prognosis.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
This document provides an overview and guidelines for the diagnosis and management of prostate cancer from the National Comprehensive Cancer Network. It discusses the classification, staging, diagnostic evaluation through PSA tests, biopsy and imaging. It covers management options including active surveillance, radical prostatectomy and their pre-operative preparation. Post-operative follow up, quality of life outcomes and recurrence are also reviewed based on latest evidence and guidelines.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. The benefits include reducing mortality from prostate cancer by detecting it at an early stage, but screening also commonly results in false positives.
2) Common harms of screening include overdiagnosis where cancers are detected that would never have caused harm, false positives which can lead to invasive biopsies, and potential complications from treatment of screen-detected cancers including incontinence and erectile dysfunction.
3) Guidelines from organizations disagree on screening recommendations for men of different ages, but shared decision making is encouraged to weigh the benefits and harms based on individual risk factors and preferences.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
The 4Kscore® blood test for risk of aggressive prostate cancerOPKO Labs
The 4Kscore blood test uses PSA, free PSA, intact PSA and hK2 levels, along with other factors, to predict an individual's risk of having aggressive prostate cancer. It was developed over 10 years working with over 22,000 men. A US study of over 1,000 men validated that the 4Kscore accurately identified those with aggressive prostate cancer detected on biopsy. The test has greater accuracy than PSA alone and can help guide decisions on whether a biopsy is needed. Its risk assessment is included in NCCN guidelines for early prostate cancer detection.
1. The document discusses whether prostate cancer screening should be recommended for elderly men over age 65 given the high prevalence of prostate cancer but also the slow growing nature in many cases and short life expectancy.
2. While screening can detect cancer early, it also risks overdiagnosing biologically unimportant cancers and subjects men to potential harms of treatment without clear benefits due to their age.
3. Guidelines in the US have differing recommendations regarding screening older men, reflecting the ongoing debate around the balance of risks and benefits in this population.
1. The document discusses the debate around prostate cancer screening in elderly men over age 65, with arguments on both sides.
2. Screening may detect cancers early that would not have progressed or caused harm in a man's lifetime given his life expectancy. However, screening also risks overdiagnosis and overtreatment of biologically unimportant cancers.
3. Guidelines in the US do not recommend routine screening for low-risk, elderly patients due to the scientific uncertainties around the balance of benefits and harms. Patient-clinician discussion is important to make informed, individual decisions.
The PSA test measures levels of prostate-specific antigen in the blood to screen for prostate cancer. High PSA levels could indicate prostate cancer but can also be caused by other prostate conditions. There is conflicting advice about PSA testing and whether a man should get tested depends on discussing risks and benefits with their doctor. In addition to a PSA test, doctors may perform a digital rectal exam to check the prostate for abnormalities. The US Preventive Services Task Force currently recommends against PSA screening because many men are harmed by overtreatment while few benefit, as better tests and treatments are still needed.
1) A study called PIVOT compared radical prostatectomy to observation in men with early stage prostate cancer over 12 years and found no significant difference in mortality. An extended follow up of PIVOT over 20 years still found no significant difference in all-cause or prostate cancer mortality between the two groups.
2) Absolute differences in mortality risk increased slightly over time but remained small, with less than a 6 percentage point difference in all-cause mortality and 4 percentage points for prostate cancer mortality. Surgery was associated with less disease progression but most progression was asymptomatic.
3) The study concludes that radical prostatectomy was not associated with significantly lower mortality compared to observation over 20 years. Death from prostate cancer was very uncommon
The document summarizes the key findings and implications of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The trial found that for men with low-risk prostate cancer, radical prostatectomy did not provide a benefit over observation in reducing mortality rates. This suggests that observation may be a reasonable option for some low-risk prostate cancer patients over age 60. However, the trial also implied that radical prostatectomy may provide survival benefits for those with higher-risk disease. The document discusses several limitations of the PIVOT trial and ongoing debates around the management and treatment of localized prostate cancer.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Prostate cancer is a relatively common cancer in men over 60. If not treated early, it can spread from the prostate to bones and lymph nodes. Symptoms may include bone pain, urinary problems, erectile dysfunction, pelvic discomfort, and weak urine stream. Services offered to treat prostate cancer include radiation therapy, hormonal treatment, surgical removal of the testicles or prostate gland, and transurethral resection of the prostate. Men experiencing symptoms should book an appointment with a urologist.
This document summarizes a study analyzing media coverage of updated prostate cancer screening guidelines from the USPSTF and AUA. The study found that:
1) 92 news articles were analyzed from 2011-2013 covering the preliminary 2011 USPSTF guidelines, final 2012 guidelines, and 2013 AUA guidelines.
2) Articles frequently emphasized potential downsides of screening and inaccurately summarized guidelines/evidence.
3) Coverage of the USPSTF announcements was more extensive than the AUA guidelines.
4) Urologists were commonly interviewed but articles also cited costs and urologists' financial interests in screening.
5) The study provides insight into how media shapes views of
This case study discusses treatment options for a 45-year-old man with low risk prostate cancer based on an elevated PSA. Screening is recommended due to his family history of prostate cancer in his father. Further testing reveals a small, low grade tumor. He is a candidate for active surveillance, brachytherapy, or radical prostatectomy. Active surveillance is preferred given his age and low risk profile to avoid overtreatment. Brachytherapy is also an option and has advantages over external beam radiation in reducing dose to surrounding organs. Close monitoring is needed as most low risk prostate cancer patients will not require immediate treatment.
Prostate cancer screening and early detection is an ongoing area of research and debate. While screening can detect prostate cancer earlier when it may be more treatable, it also leads to overdiagnosis and overtreatment. Several large clinical trials have had conflicting results on the benefits of prostate cancer screening. Guidelines from organizations also vary in their recommendations for screening. New biomarkers and imaging techniques are being studied to improve screening specificity and reduce unnecessary biopsies and treatment. Overall, the effectiveness of prostate cancer screening remains uncertain, and any decision to be screened requires informed discussion of risks and benefits.
This seminar discussed screening for carcinoma of the prostate. It was chaired by Prof. C. S. Ratkal and co-chaired by Dr. M. Shivalingaiah. Dr. Prakash H. S. presented on various screening modalities including digital rectal examination (DRE), prostate-specific antigen (PSA) testing, prostate biopsy, and imaging. PSA testing combined with DRE is the most useful first-line screening approach. While screening can detect early-stage cancers, it also risks overdiagnosis and overtreatment of indolent tumors. The benefits and limitations of prostate cancer screening continue to be debated.
Mon 8-00 Prostate Cancer Screening in the Post-USPSTF Era_0.pptxRonitEnterprises
This document discusses prostate cancer screening and recommendations. It begins with a case presentation of a 54-year-old man before discussing the US Preventive Services Task Force recommendations against PSA screening. It then reviews the goals of cancer screening, basics of PSA testing and prostate cancer, impact of the Task Force, and ways to improve screening through risk stratification using newer biomarkers, imaging, and genetic profiling to avoid overdiagnosis while identifying high-risk cancers.
This document discusses the management of intermediate and high risk prostate cancer. It begins by providing background on prostate cancer epidemiology and risk stratification. It then covers various treatment options including observation, active surveillance, radical prostatectomy, radiotherapy, and androgen deprivation therapy. Several studies comparing the efficacy of radiotherapy alone versus radiotherapy with short or long-term ADT are summarized. For intermediate risk prostate cancer, the document recommends 4-6 months of ADT with radiotherapy based on trial results. For high risk prostate cancer, 2-3 years of ADT with radiotherapy is recommended.
Pros and cons of prostate cancer screening by mungai ngugiKesho Conference
1) Prostate cancer screening can have both benefits and harms. While screening may help reduce mortality by detecting cancer early, it can also lead to overdiagnosis and false positive results that cause unnecessary biopsies and treatments with side effects.
2) Guidelines from organizations like the U.S. Preventive Services Task Force and American Urological Association recommend shared decision making for men ages 55-69, as screening in this group balances a potential reduction in mortality with known harms. Screening is not routinely advised for men under 40 or over 70.
3) Trials show screening every 2 years may preserve benefits of screening while reducing overdiagnosis and false positives compared to annual screening. However,
Prostate cancer molecular bio markers seminarHarshaR35
This document discusses various molecular biomarkers for prostate cancer that have been approved by regulatory agencies or are under investigation. It begins by providing background on prostate cancer statistics and the rationale for biomarkers. It then discusses currently approved blood-based biomarkers like PSA, PHI, and 4Kscore. Circulating tumor cells and cell-free DNA are also mentioned. Finally, it briefly summarizes urine-based biomarkers like PCA3 and potential new serum protein panels. In general, the document reviews both established and emerging liquid and tissue-based biomarkers that could improve prostate cancer screening, diagnosis, and monitoring.
Nuclear imaging techniques play various roles in prostate cancer assessment and management. Conventional bone scintigraphy using technetium-99m is effective for detecting bone metastases, though it lacks specificity. PET tracers like FDG have limited utility in prostate cancer due to typically low glucose metabolism in prostate tumors. However, PET may help stage more aggressive primary tumors or locate recurrent disease when conventional imaging is negative. Newer tracers targeting prostate-specific membrane antigen (PSMA) show promise, with radioimmunoscintigraphy using Indium-111-capromab demonstrating reasonable sensitivity and specificity for detecting prostate cancer lesions.
This document discusses cancer screening for seniors and whether it makes sense. It notes that reasons not to screen everyone include costs, potential harms from false positives or procedures, and factors related to life expectancy and health status. It provides examples of famous people who died of pancreatic cancer and notes that screening for pancreatic cancer is not recommended. It asks questions about the most common cancers, typical cancer ages, beneficial screening tests, and best screening advice. It discusses stopping screening at age 75 but continuing for those expected to live 10 more years. It provides resources on cancer screening guidelines.
This document summarizes information about prostate cancer, including statistics on incidence and mortality rates in the United States. It discusses various screening and treatment options for prostate cancer. Key points include: lifetime risk of developing prostate cancer is 16.2% for men; screening with PSA and digital rectal exam has not been proven to reduce mortality; watchful waiting or active surveillance are appropriate for very low or low risk prostate cancer depending on life expectancy; radical prostatectomy and radiation therapy offer similar cure rates for early stage disease but have different side effect profiles.
Prostate cancer updates were presented. Key points include:
1) The Gleason score is used to assess tumor aggressiveness and has shifted to include higher scores over time.
2) Screening results do not support widespread mass screening, but early detection may be offered to informed men with baseline PSA testing at age 40 and screening intervals of 8 years if initial PSA is low.
3) For localized disease, treatment options include active surveillance, radical prostatectomy, or radiation therapy depending on risk level and life expectancy. Deferred treatment may be appropriate for many cases.
This document discusses management strategies for localized prostate cancer, including active surveillance and radical prostatectomy. It notes that active surveillance involves delayed treatment if cancer progresses, allowing patients to avoid or delay unnecessary treatment. However, criteria for patient selection and treatment triggers require further definition and validation. Radical prostatectomy remains the gold standard for treating localized prostate cancer as it offers the possibility of cure while minimizing damage to surrounding tissues when performed skillfully. Innovations have led to improved preservation of urinary continence and erectile function with this procedure.
This document provides an overview of prostate cancer including epidemiology, risk factors, screening recommendations, clinical presentation, diagnosis, staging and risk stratification. Some key points:
- Prostate cancer is the second most common cancer in men worldwide. Incidence and mortality increases with age.
- Risk factors include age, family history, metabolic syndrome, certain dietary factors and medications.
- Screening is recommended for men aged 55-69 with a PSA test and digital rectal exam. Screening intervals depend on PSA levels.
- Diagnosis involves PSA testing, digital rectal exam, and biopsy. Staging uses the Gleason score and TNM system to determine risk level and treatment options
This document discusses recent advances in prostate cancer, including updated screening guidelines, diagnostic tools, biomarkers, staging, and treatments. It provides an overview of prostate cancer epidemiology and risk factors. Screening involves PSA testing and digital rectal exams for men aged 55-69. Multiparametric MRI and MRI-ultrasound fusion biopsies have improved detection of aggressive cancers. Staging involves bone scans, PET scans, and the TNM system. Biomarkers like PSMA and PCA3 are also discussed.
Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing
Objective: To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis.
Conclusion: Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.
This document discusses the value of prostate-specific antigen (PSA) testing and Gleason scoring in the management of prostate cancer. It provides background on PSA biology and testing, outlines the Gleason grading system, and explains how PSA levels and Gleason scores are used for prostate cancer diagnosis, prognosis, treatment selection and follow-up. PSA and Gleason score together provide important information about cancer aggressiveness and help guide clinical decision-making.
This document provides an overview and updates on prostate cancer pharmacotherapies. It discusses the anatomy and physiology of the prostate, risk factors for prostate cancer like diet and genetics, screening methods including PSA tests and digital rectal exams, diagnostic workup involving imaging and biopsies, tumor staging using Gleason scores and TNM classification, and treatment strategies at different stages including radiation, surgery, and hormone therapies. Controversies around PSA screening and increasing legal risks for failure to diagnose are also reviewed.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
Prostate Cancer - Current Approach and Future Perspective in Castration-Resis...KCR
Prostate carcinoma is one of the most commonly diagnosed solid tumours in males worldwide. Selection of the treatment method is strictly dependent upon disease stage and the patient’s age. Availability of diagnostic tests is constantly increasing in clinical practice, allowing early diagnosis and better chances for complete and permanent recovery. In the case of locally advanced prostate carcinoma, radical surgery or radiotherapy is considered as the most effective therapeutic approach, whereas in metastatic prostate carcinoma, hormone therapy or androgen deprivation therapy (ADT) is the primary therapeutic option. Moreover, increased use of chemotherapy with docetaxel and cabazitaxel in clinical practice has resulted in better prognosis for patients in this advanced stage of the disease.
The biggest challenge for doctors and patients remains the treatment of hormone-resistant carcinoma (which very often is also metastatic). Concerns of today’s medicine regarding effective therapies for this type of disease have recently led to a significant increase in the number of papers/studies on new-generation biological treatments.
Semelhante a Prostate cancer - Vincent Batista Lemaire (20)
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Prostate cancer - Vincent Batista Lemaire
1. PI-RADS PROSTATE IMAGING-REPORTING
AND DATA SYSTEM: 2015,VERSION 2
Dr. Vincent Batista Lemaire
Locum Consultant Radiologist
St. Richards Hospital ,West Sussex Hospitals Trust, NHS .
Chichester , England , UK .
2. PI-RADS PROSTATE
IMAGING-REPORTING
AND DATA SYSTEM:
2015,VERSION 2
F R O M C O L L A B O R A T I O N O F A M E R I C A N
C O L L E G E O F R A D I O L O G Y
( A C R ) , E U R O P E A N S O C I E T Y O F
U R O R A D I O L O G Y ( E S U R ) A N D A D M E T E C H
F O U N D A T I O N
4. - Worldwide , there are and estimated 1,600,000 new cases of
prostate cancer and 366,000 prostate cancer death annually,
making it the most commonly diagnosed cancer in men and the
seventh leading cause of male cancer death .
- Prostate cancer is the second most commonly cancer diagnosed
in the United States after skin cancer, with 161,000 new prostate
cancer diagnoses and approximately 26,700 prostate cancer
deaths.
- 1 in 6 men would develop prostate cancer in their lifetime; however
, only 1 in 34 men would die from prostate cancer.
- Good prognosis but some are aggressive .
- 70% of death due to prostate cancer occur after age 75.
5. - Older age is the strongest risk factor for the development of prostate
cancer.
- Black men are twice as likely to die of prostate cancer than other
men.
- Family history have an increase risk of 2.5 fold
- The risk of prostate cancer among men with elevated PSA levels is
lower in men with urinary symptoms than in men without symptoms.
6. How to make the diagnosis and deliver the best preventive and
treatment options?
8. Sensitivity is the number of true positive results divided by the sum of
the true positive results and false negative results .
Specificity is the number of true negative results divided by the sum
of the true negative results and false positive results .
Our primary goal is to find a screening strategy that will improve
sensitivity without sacrificing specificity.
10. One study of 6,630 men volunteering for DRE and prostate-specific antigen
screening tests, 45% of the cancers that were detected were missed by the
DRE. Other authors have reported finding cancer in 15% to 18% of men with
a normal DRE.
If a lump is found, the chances are about 1 in 4 that it is cancerous.
Abnormal prostate findings include nodules, asymmetry, or induration. DRE
can detect tumours in the posterior and lateral aspects of the prostate gland;
an inherent limitation to the digital examination is that only 85 percent of
cancers arise peripherally where they can be detected with a finger
examination [86]. Stage T1 cancers are non palpable by definition.
Digital rectal exam
11. DIGITAL RECTAL EXAM
A new study found that, while not 100% accurate, digital rectal examination
(DRE) should remain a standard for screening for prostate cancer and may
even be able to identify cases of the disease that are not picked up by
the prostate specific antigen (PSA) test. The results of the study were
reported in The Canadian Journal of Urology.
Our study confirms that the digital rectal exam remains an important part of
screening such patients because 31 percent of cancers in our study would
have been missed by using age-specific PSA cut offs alone,” Raman said
12. The DRE is also inexpensive, costing approximately $28 (Crawford
et. al. 1999). Though it is readily available by appointment in a
doctor's office, there is discomfort for the patient and a risk of slight
bleeding (American Cancer Society 2006).
With the DRE test, the experience of the doctor is of utmost
importance, yet, new, inexperienced urologists often perform the test.
The sensitivity is 27.1% and the specificity is 49.0% (Marcus
2004).
Digital rectal exam
13. PROSTATE-SPECIFIC ANTIGEN (PSA) — PSA is a glycoprotein
produced by prostate epithelial cells. In men with prostate cancer
PSA production is increased and the tissue barriers between the
prostate gland lumen and the capillary are disrupted. PSA elevations
can precede clinical disease by 5 to 10 years.
Screening: beginning at age 50, though not with men who have a
comorbidity that limits their life expectancy to less than 10 years .
We suggest that providers first discuss screening with men at high
risk for prostate cancer, including black men, men with a family
history of prostate cancer, particularly in relatives younger than age
65, and men who are known or likely to have the BRCA1 or BRCA2
mutations, beginning at age 40 to 45.
PSA
14. PSA
*The PSA test is simply a blood test, widely available to the general
population.
* It is costs the patient roughly $30 to $60.
* The sensitivity is 64% and the specificity is 91% .
15. PSA
Serum PSA levels were considered normal if they fell into specific thresholds
based
on age :
<50 years, PSA <2.5 ng/mL;
51-60 years, PSA <3.5 ng/mL;
61-70 years, PSA <4.5 ng/mL;
and >70 years, PSA <6.5 ng/mL).
16. PSA
The traditional cut off for an abnormal PSA level in the major screening studies
has been 4.0 ng/mL. .
In a pooled analysis, the estimated sensitivity of a PSA cut off of 4.0 ng/mL was
21 percent for detecting any prostate cancer and 51 percent for detecting
high-grade cancers (Gleason ≥8). Using a cut off of 3.0 ng/mL increased
these sensitivities to 32 and 68 percent, respectively. The estimated
specificity was 91 percent for a PSA cut off of 4.0 ng/mL and 85 percent for a
3.0 ng/mL cut off. PSA has poorer discriminating ability in men with
symptomatic benign prostatic hyperplasia [48].
17. PSA: NATIONAL COMPREHENSIVE CANCER
NETWORK :GUIDELINES 2014
1. Baseline testing at age 45-49 years with retesting at 50 years in patent with a
level below 0.7ng/ml.
2. Annual or biannual retesting in those with a level of 1.0ng/ml or higher.
3. For patient aged 50-70 years with a normal RE and PSA below 3 ng/ml, the
NCCN recommends retesting every 1-2 years.
18. ELEVATED PSA
- DRE : transient elevation from 0.26 to 0.4ng/ml
- Ejaculation : can increase PSA levels by up to 0.8 ng/mL, though levels return to
normal within 48 hours.
-Bacterial prostatitis; Asymptomatic prostatic inflammation can also elevate PSA
levels, but this diagnosis is made on biopsy and so cannot generally be used
to defer screening
-Prostate biopsy , transurethral resection of the prostate (TURP): A screening
PSA test should not be performed for at least six weeks following either of
these procedures.
-Acute urinary retention.
19. PSA
PSA: relatively low sensibility , increased PSA is not equivalent with
tumour..
Screening is controversial: over diagnosis and overtreatment
20.
21. TRUS biopsies based on a systematic approach tend to target the peripheral
aspects of the gland and are likely to miss 30-40% of prostate cancer located in the
anterior, midline transition zone, or apex. Today, however, many tumours are being
identified at a very early stage, often as extremely small lesions that are hard to spot
on
ultrasound and hard to sample using a TRUS biopsy alone.
"If we adopted this approach, we could reduce the number of men needing biopsies
by
50% (223 vs 109), we could reduce the biopsy cores we took by 80% (2672 vs 322)
and,
most importantly, we could reduce the diagnosis of low-risk prostate cancer by up
to
90% (47 vs 5), and still we'd find 12% more intermediate- to high-risk cancers (79 vs
89).
“For patients with intermediate- to high-risk cancer, the estimated sensitivity of MRI
plus
biopsy was 92.34% — "far outperforming that of the TRUS plus biopsy (70.44%),"
said
TRUS BIOPSY
25. *Clinically significant cancer was defined as Gleason score 4+3
or
a maximum cancer core length of 6 mm or longer .
*MRI picks up 93% of aggressive cancers , compared with 48%
for
biopsy.
*More than a quarter (27%) of all men with suspected cancer
could
avoid a biopsy .
*If subsequent TRUS-biopsy were directed by MP-MRI findings,
up to
18% more cases of significant cancer might be detected .
27. The scoring system is named after Donald Gleason (1920-2008), a
pathologist at the Minneapolis Veterans Affairs Hospital, who developed it
with colleagues at that facility in the 1960s. In 2005, the Gleason system
was altered by the International Society of Urological Pathology. The criteria
were refined and the attribution of certain patterns changed. It has been
shown that this 'modified Gleason score' has higher performance than the
original one, and is currently assumed standard in urological pathology.
Gleason grading system
28. GLEASON GRADING SYSTEM
A total score is calculated based on how cells look under a microscope, with
half the score based on the appearance of the most common cell
morphology (scored 1—5), and the other half based off the appearance
of the second most common cell morphology (scored 1—5). These two
numbers are then combined to produce a total score for the cancer.
The Gleason Grade/Score has two main points: 1: Based on architectural
patterns, rather than cytological ones. The second feature of Gleason
grading is that the grade is not based on the highest (least
differentiated) pattern within the tumor, instead it is a combination
of the most often and second most often patterns seen. Gleason
realized that prostatic carcinomas have multiple patterns and that the
prognosis of prostatic carcinoma was split between the most prevalent
and the second most prevalent neoplasm pattern.
29. GLEASON GRADING SYSTEM
What does it mean?
A Gleason score
A 2 and 6 is a low grade prostate cancer, likely to grow very slowly. A
Gleason score of 7 is an intermediate grade that will grow at a moderate
rate. A Gleason score of 8 to 10 is a high grade cancer that is likely to grow
more quickly.
If your Gleason score is low and you are older or have early stage disease
your urologist is likely to suggest active monitoring rather than surgery or
radiotherapy. This is because your cancer may not spread or have any impact
upon your health. If you have a high Gleason score, are younger or have
higher stage disease, your urologist is more likely to suggest you have active
treatment.
30. GLEASON 3+4 AND GLEASON 4+3
Despite the confusing numbering system, 3+3 is the lowest possible
Gleason score reported today. 3+3 doesn't metastasize, and some
pathologists, therefore, don't even think it should be called "cancer." It is
generally, depending on other case characteristics, low-risk.
Gleason scores that add up to 7 are generally intermediate risk. 3+4 is
generally a favourable intermediate risk, and 4+3 is generally an
unfavourable intermediate risk. The difference is the amount of Gleason
pattern 4 cells present. The more pattern 4, the more aggressive the tumor.
3+4 means less than 50% pattern 4, and 4+3 means greater than 50%
pattern 4.
33. GLEASON GRADING SYSTEM
1. Multifocal and heterogeneous cancer is
common , occurring in 60%
2. Cancer with high Gleason score are more likely
to exhibit pronounced imaging characteristic
on mpMRI with accordingly high PI-RADS
scores.
3. Early stage Gleason score 3+ 3, mpMRI does
poorly .
34. ZONAL ANATOMY OF THE PROSTATE
GLAND
John E Mc Neal ,1930-
2005, worked at Standford
39. FASCIA AROUND THE PROSTATE
1.prostatic fascia: anteriorly and antero-laterally , it is in direct continuity
with the fibromuscular stroma .
2.Laterally : it fuses with the endopelvic fascia.
3.posteriorly , it fuses with , and is indistinguishable from , Denonvilliers
fascia with lies between the prostate and the rectum and covers the
seminal vesicle posteriorly .
40. PELVIC FASCIAE IN UROLOGY
B RAYCHAUDHURI AND D CAHILL
THE ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND 2008 90:8, 633-637
The findings of the study were as follows:
The ‘capsule’ of the prostate does not exist. Rather, the fibromuscular band
surrounding the prostate forms an integral part of the gland.
The prostate is surrounded by fascial structures – anteriorly/anterolaterally
by the prostatic fascia and posteriorly by the Denonvilliers' fascia.
Laterally, the prostatic fascia merges with the endopelvic fascia.
The posterior longitudinal fascia of the detrusor comprises a ‘posterior
layer’ of the detrusor apron, extending from the bladder neck to the
prostate base.
The neurovascular structures tend to be located posterolaterally, at 5 and 7
o’clock ,but may not always form a bundle. A significant proportion of
fibres may lie away from the main nerve structures, along the
lateral/posterior aspects of the prostate.
42. PELVIC LYMPH NODE DISSECTION
Pelvic lymph node dissection (PLND) in prostate cancer is the most
effective method for detecting lymph node metastases
The accuracy of standard imaging modalities such as computed
tomography scan or magnetic resonance imaging (MRI) in detecting
nodal metastases remains poor.
43. MULTIPARAMETRIC MRI
Axial T1 LFOV Pelvis
Axial, coronal, (sagittal) T2 SFOV Prostate
Axial DWI (b=0,150,500,1000) with ADC map
High b value (b1400, b2000)
Volume T1 fat sat (VIBE)
pre- and dynamic post-contrast
44. MULTIPARAMETRIC MRI
1. It is not intended to make a diagnosis .
2. The main goal is to suggest the target site in patient with suspicious
findings .
50. ANATOMY OF THE PROSTATE
A normal prostate gland is approximately 20 gr in volume, 3 cms in length,
4 cms wide and 2 cms depth . The base of the gland is in continuity to
the bladder, and anterior to the rectum. The prostate ends at the apex
before becoming the striated external urethral sphincter. The sphincter
is a vertically oriented tubular sheath that surrounds the membranous
urethra and prostate.(Maruve,Nicolas)
Volume uses the ellipsoid formula : height x width x length transverse
diameter x 0.52 (Phi/6 =0.52)
68 y/o ; 255 g
64. ESUR/ACR GUIDELINES V2
PI-RADS DEFINITION OF TOTAL SCORE
PI RADS CLASSIFICATION DEFINITION
1 MOST PPROBABLLY BENIGN
2 PROBABLY BENIGN
3 INDETERMINATE , EQUIVOCAL
4 PROBABLY MALIGNANT
5 HIGHLY SUSPICIOUS OF
MALIGNANCY,
65. MRI SPECTROSCOPY
1. ESUR v1
2. Citrate is synthesized and stored in large quantities in normal glandular
tissue of the prostate and is therefore used as an organ marker for
healthy prostate tissue.
3. Choline refers to the sum of choline-containing compounds. The
intensity of choline reflects the extent of membrane turnover and is
significantly elevated in cancerous tissue.
67. STAGING THE PROSTATE CANCER
T1: too small to be seen , T3: T3a,has broken through the capsule
biopsy + T3b, has spread into de seminal vesicle
T2: T2a: in only half of one lobe . T4: spread into other body organs nearby, such
T2b: more than half of one lobe. as rectum , bladder, muscles or side of
T2c: more than one lobe pelvis
68. EXTRACAPSULAR EXTENSION MAKE A T3
Criteria for extracapsular extension :
Irregular bulge in the capsule.
Obliteration of the recto prostatic angle
Asymmetry in the neurovascular bundle
Angulation /step off appearance
Focal capsular retraction or thickening
Breach of the capsule with evidence of tumour extension
LENGTH OF CASPSULAR CONTACT WITH A CUT OFF =15 MM
69. STAGING AND RISK GROUP
I Have Heard That Other Factors May Be Included When Evaluating
Treatment.
Yes, other factors such as the number of biopsies and the presence of Gleason
Score 7 (4+3) versus a Gleason Score (3+4) may influence the treatment
decision. The number of + biopsies is also strongly predictive of outcomes but
not typically part of the risk grouping systems. An example would be a person
with a multiple + biopsies (>34%-50%) Gleason 7. His cancer would be
considered a High Intermediate Risk and require a combination of External
Beam and radiation while another patient with only a few + biopsies (< 34%-
50%) could be a Low Intermediate Risk patient and be a good candidate for
an implant alone. These factors should be discussed with you
doctor.(Prostate cancer center of Seattle)
Summarised: multiple biopsies >34% and more than 5 mm are high risk
factors.
Gleason 4+3=7 or higher, PSA >20 ng and more important ,T3 or higher.
70. STAGING AND RISK GROUP
What is My Risk Group?
Low, Intermediate and High Risk groups have been identified by NCCN (National
Comprehensive Cancer Network) and D’Amico classifications.
Low Risk: (NCCN and D’Amico) – PSA < 10.0 And Gleason Score < 7 cT1c-T2a
Intermediate Risk: NCCN – PSA > 10.0 < 20.0 And/Or Gleason = 7 And/Or cT2b-
c D’Amico – PSA > 10.0 < 20.0 And/Or Gleason = 7 And/Or cT2b
High Risk: NCCN – PSA > 20.0 And/Or Gleason 8-10 And/Or cT3 Or 2 or More
Intermediate Risk Features D’Amico – PSA > 20.0 And/Or Gleason 8-10
And/Or cT2c-T3
71. STAGING PROSTATE CANCER
Very low risk clinically localized prostate cancer is defined as disease detected
by
biopsy only (no abnormalities detected on rectal examination or imaging),
Gleason
score of 6 or less on biopsy and a serum PSA <10ng/ml. Within the prostate, the
extent of disease must be limited (fewer than three positive biopsy cores with less
than 50% involvement in any core and a PSA density of less than 0.15
ng/mL/gram.2
Low risk, clinically localized prostate cancer is disease limited to one lobe of the
prostate or with no apparent tumor (diagnosis based only on biopsy, serum PSA
< 10
ng/ml and a Gleason score ≤ 6.
72. STAGING PROSTATE CANCER
low-risk PCa (clinical stage T1–T2a, biopsy Gleason score 6 or less, and PSA
less than 10 ng/mL); 556 (35.7%) had intermediate-risk disease (clinical
stage T2b – T2c, biopsy Gleason score 7, or PSA 10–20 ng/mL); and 343
(22%) had high-risk PCa (clinical stage T3a, biopsy Gleason score 8–10, or
PSA greater than 20 ng/mL).
The researchers designated intermediate-risk PCa as unfavorable if it met at
least 1 of the following 2 criteria: biopsy Gleason score 4 + 3 and/or presence
of 2 or more intermediate-risk criteria. All other men with intermediate-risk
PCa were designated as having favorable intermediate-risk disease
83. PROSTATE CANCER :AFS
1. The anterior fibromuscular stroma is devoid of glands .
2. Could form up to 30% of the gland .
3. No prostate tumour arise from it apart of the very rare sarcomas.
4. Could be affected by tumour arising from the anterior PZ or the anterior
TZ .
5. Low signal on T2W.
84. PROSTATE CANCER TZ
1. The central zone surrounds the ejaculatory ducts and consist of 25%
of the glandular tissue and origins 1-8% of prostate cancer and the TZ
the 20%.
2. The TZ surrounds the urethra and the epithelium consist of transitional
cells similar to bladder epithelium.
3. The most common patter is benign prostatic hyperplasia where there
are well defined nodules , hyperintense when made of hyperplasic
glands or hypointense when they are made of hyperplastic stroma .
4. Most of the cases will show enhancement .
5. The most common report for TZ will be PI-RADS 2 , probably benign .
113. TZ: 68 Y/O ;PSA 26 ; DRE : FIRM , 47G
15 months later ,PI-RADS 5 , capsular and seminal vesicle invasion , bony
mets, Gleason 4+5=9
114. PROSTATE CANCER CENTRAL ZONE
69 Y/O , PSA 5.3; DRE FIRM RIGHT LOBE ;
DILATED DUCT AND LOW SIGNAL. PI-RADS 4
115. PROSTATE CANCER:PZ
From 70-80% of adenocarcinoma arise in the PZ
The dominant sequence would be the DWI followed by the T2
The most common report would be PI-RADS 1 .
172. ACTIVE SURVEILLANCE (AS)
- Strategy that delays curative therapy for low risk disease
- In low grade 3+ 3=6 Gleason , to avoid over treatment.
- In intermediate grade (Gleason 3+4) low volume disease to delays-postpone
treatment until require
ICIS: Masterclass in Imaging
of prostatic cancer 22nd
January 2016
173. ACTIVE SURVEILLANCE (AS)
On low-risk patient for AS, monitoring involves:
- PSA testing every 3 months for 2 years, then every 6 months: using PSA
velocity over 0.75ng/ml/year would allow the identification of men with
progressive disease who would benefit from a follow-up imaging exam.
- Regular DRE
- MpMRI every 2 years, very accurate detecting tumor >0.5 cc volume
ICIS: Masterclass in
Imaging of prostatic cancer
22nd January 2016
174. ACTIVE SURVEILLANCE (AS)
- The absence of a detectable lesion (that is PI-RDAS 1,2, and probably 3)
make a patient suited for AS .
- Patient with PI-RADS 4 and 5 should not undergo AS
- Unfavourable features:
- Low mean ADC values of intra-prostatic dominant lesions are correlates with
higher Gleason scores. Cut value: 1000 micro m2/s
- A tumor contact length with the prostatic capsule of more than 15 mm
increases risk of having pathological ECE.
- PSA level> 10ng/ml
ICIS: Masterclass in Imaging
of prostatic cancer 22nd
January 2016
175. WATCHFUL SURVEILLANCE:
Foregoes curative therapy of prostate cancer due to attendant co-
morbidities and initiates interventions only when symptoms occur.
ICIS: Masterclass in
Imaging of prostatic cancer
22nd January 2016
176. PRECLUDES RADICAL SURGERY
Extensive ECE/SVI.
CT or whole body DWI for TNM staging lymphadenopathy . The
prevalence of metastasis in operated apparently N0 disease is 20-
30% in intermediate risk and 30-40% in high risk disease.
Nerve sparing surgery is usually not performed in the side of a palpable
tumor when serum PSA level >20ng or Gleason score > 8
ICIS: Masterclass in
Imaging of prostatic cancer
22nd January 2016
177. TREATMENT OPTIONS
A. pT2 : assuming no capsular involvement:
1. Prostatectomy : da Vinci Robotic assisted best surgical procedure.
2. Proton beam therapy + hormones : best non surgical approach. Very
expensive.
3. Image assisted Intensity modulated radiotherapy + hormones . Less
expensive and widely available.
4. Brachytherapy + hormones .
5. Gamma knife ; HIFU ; others .
B. pT3: suspicious of capsular involvement : proton beam therapy + hormones ;
IMRT+ hormones; Brachytherapy +IMRT+ hormones .
C.pT3b or higher: chemotherapy is added
Note: hormone increase the efficiency of proton beam, IMRT and brachytherapy .
180. BIBLIOGRAPHY
Bibliography:
Final Recommendations Statement: prostate cancer: Screening. U.S. Preventive Services Task Force. October 2014.
Thomas R Gest , Prostate Anatomy Medscape /1923122
Raychaudhuri and Cahili, Pelvic fasciae in Urology ,RCS annals, Vol :90Issue:8, Nov 2008, pp633-637.
Kennth Iczkowski, Prostate carcinoma : core biopsies Pathology Outlines 2003-2016.
R H Oyen et al , Benign hyperplastic nodules that originates in the peripheral zone of the prostate gland ,: RSNA
Radiology , December 1993, Vol 189, issue 3 .
Jelle O. Barentz et al. ESUR prostate MR guidelines 2012: Eur(2012)22: 746-757
Jeffrey C. Weinreb et al . PI-RADS Prostate Imaging-Reporting and Data System: 2015, Version 2 . Eur Urology 69
(2016) 16-40.
Jelle O.Barentz wet al. Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance
Imaging and Recommendations for Use. European Urology 69 (2016) 41-49.
John Kurhanewicz at al. Multiparametric magnetic resonance imaging in prostate cancer: present and future. Curr.
Opin Urol.2008 January ; 18(1): 71-77.
Janet NL wt al. Sarcoma of the prostate: a single institutional review. Am J Clin Oncol, 2009 Feb; 32 (1): 27-9
Arda Kayhan et al. Multi-parametric MR imaging of transition zone prostate cancer: Imaging features, detection and
staging. World/Radiol 2010 May 28; 2 (5): 180-187
M. Rothkle et al. PI-RADS Classification : Structured Reporting for MRI of the Prostate: Magneton Flash; Issue 4/2013,
30-38
Heminder Sokhi; Anwar R Padhani. Whole Body Diffusion-Weighted MRI for Bone Marrow Tumor detection. Magneton
Flash ; Issue 4/2013,pp6-12
Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: Efficacy, Limitations, and
Complications—A Systematic Review of the Literature Guillaume Ploussard a,b,c,*, Alberto Briganti d, Alexandre
de la Taille c,e, Alexander Haese f, Axel Heidenreich g, Mani Menon h, Tullio Sulser i, Ashutosh K. Tewari j,
James A. Eastham k
Hashim U Ahmed , et al . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS):
a paired validating confirmatory study. Lancet Vol:389, February 25, 2017.