Prostate Cancer

Question 1

What are the guidelines on screening for prostate cancer?

Answer 1

Screening asymptomatic men is not recommended

—–>
Patients who request testing should be informed about the risks and benefits of tests for prostate cancer, and should be assisted to make their own decision using an acceptable decision aid.

Not Men with uncomplicated Lower Urinary Tract Symptoms do not appear to have an increased risk of prostate cancer

(RACGP RED BOOK)

Question 2

1/ What are the high risk factors?

Answer 2

1/ Men with 1 or > relatives diagnosed <65yrs of age

2/ Men with 1st degree relative with familial breast Cancer (BRCA1 BRCA2)
(RACGP redbook)

3/ Overweight + obesity are risk factors [wiki.cancer.org.au]

Question 3

If a PSA is being ordered which factors need to be considered?

Answer 3

Men should not have a PSA test if they have:
• an active urinary infection;
• ejaculated in the last 48 hours;
• exercised vigorously in the last 48 hours;
• had a prostate biopsy in the last 6 weeks; or
• had a DRE in the past week.

(Ref: NHMRC PSA testing for prostate Ca in asyx men)

Question 4

What are the statistical possible benefits of PSA testing?

Answer 4

1/ For every 1000 men tested 2 will avoid death from prostate Ca before 85yrs

From every 1000 men tested 2 will avoid metastatic prostate cancer before 85yrs

(Ref: NHMRC PSA testing for prostate Ca in asyx men)

Question 5

What are the statistical expected harms of PSA testing?

Answer 5

For every 1000 men tested
—> 87 men who do not have prostate cancer will have a false + PSA test that will lead to a biopsy

–>28 men will have a side effect from biopsy (moderate to major) & 1 will require hospitalisation

For every 1000 men tested
–> 25 will choose tx
7-10 of these 25men will develop impotence, uruinary incontinence, some will have persistent bowel problems

For every 2000men tested 1 will have serious CVD event e.g. AMI

(Ref: NHMRC PSA testing for prostate Ca in asyx men)