ACCURACY OF PSA TEST IN THE PROSTATE CANCER SCREENING PROGRAM OF LITHUANIA

Size: px
Start display at page:

Download "ACCURACY OF PSA TEST IN THE PROSTATE CANCER SCREENING PROGRAM OF LITHUANIA"

Transcription

1 ACCURACY OF PSA TEST IN THE PROSTATE CANCER SCREENING PROGRAM OF LITHUANIA Romualdas Gurevičius 1, Renata Šturienė 2, Arvydas Šilys 3 1 Institute of Hygiene, 2 Vilnius Šeškinė Outpatient Clinics, 3 Vilnius University Clinics Summary In Lithuania, prostate cancer accounts more than a quarter (29%) of newly diagnosed cases of cancer in males. Since 2006 Prostate cancer screening programme in Lithuania began inviting, asymptomatic men aged for a PSA test, which uses a cut-off value of greater than 3ng/ml. Aim of the study. To evaluate PSA test accuracy of a clearly defined screened population with application different statistical indicators. Material and methods. The outpatient clinic in which investigation was carried out serves 97,000 of Vilnius city residents, including 45 thousand men, of which about 11 thousand are years of age. During the period of information on all screened males (N=8810) were collected, covering 80% of the target population. Results and conclusions. In our study, the sensitivity of the PSA test was 74.8% (95% CI: ), the specificity of the PSA test was 90.7% (95% C ). False positive rate shows 9,3 percent of the participants in our study did not have prostate cancer but the test was positive. False negative rate indicates, that 25.2 percent of our participants had prostate cancer whiel th test was negative. Consequently, quarter of participants with false-negative results were given unfounded reassurance and 9.3% of particpants with false-positive results might have experienced unnecessary anxiety and inappropriate treatment. Area under ROC curve was 82,8% (95% CI: ), statisticaly significant, showing that discriminatory ability of the test can be interpretted as relatively good. Unfortunately, prostate cancer incidence growing, and mortality decreasing slowly, especially during recent years. This indirectly shows that national early detection (screening) program is not effective enough. One of possible reasons of this phenomenon is a lack of accessibility to the first-class treatment for the cases, diagnosed durring the screening. The fact, that only 25% prostate biopsies was made for the participants of the programme, with PSA >3ng/ml, indirectly confirming this. Keywords: prostate cancer, screening, PSA, cut-of 3ng/ml, sensitivity, specificity. INTRODUCTION In Lithuania, prostate cancer accounts more than a quarter (29%) of newly diagnosed cases of cancer in males. In 2012, last data, available from the Lithuanian cancer registry, 2606 Lithuanian men (incidence rate of 189,4/100,000) were diagnosed with prostate cancer and 585 of those diagnosed died, making it the second most common cause of cancer death in Lithuanian men after lung cancer. Prostate cancer differs from any other epithelial cancer in many ways. Due to still clearly unknown reasons, sometimes this hormone-dependant cancer remain in a latent state, without any clinical symptoms. In addition, it differs greatly within diagnosed males with regard Correspondence to Romualdas Gurevičius Institute of Hygiene, Center of Health Information Didžioji str. 22, LT Vilnius, Lithuania romualdas.gurevicius@hi.lt to aggressiveness. Currently, the main problem is unknown reasons of this phenomenon, and the lack of sensitive diagnostic tools to assess aggressiveness. All those characteristics of prostate cancer directly influence early detection policy, especially the cancer screening strategy. It must be remembered that the main aim of population-based screening program is not only early detection (increased risk of diagnosis), but to decrease mortality, or in another, words, to extend years of life. Unfortunately, according the latest evidence, prostate cancer screening results in doubling the lifetime risk of prostate cancer diagnosis with little if any decrease in the risk of dying from this disease [1]. The prostate specific antigen (PSA) screening test for early prostate cancer has been surrounded by controversy ever since it was introduced by pathologist Richard Ablin, who discovered the PSA antigen 40 years ago. Scientists repeatedly emphasize /4(83)

2 it should never have been used as a cancer screening tool (for asymptomatic persons) for all men [2]. On the other hand, there is no doubt PSA is enormously important and valuable tool in urological clinical practice, for which the test was primarily invented. Numerous approaches have been proposed to improve diagnostic accuracy of the PSA test, including measuring PSA velocity (change over time), levels of free and protein bound PSA, PSA density (the PSA level divided by prostate volume) and the cut-off values for PSA levels that are specific to the patients age, race or ethnic group [3]. Unfortunately, clinical usefulness of those strategies still remains unproved. Also, more recent studies have shown that some men with PSA levels below 4.0 ng/ml have prostate cancer and that many men with higher levels do not have prostate cancer. In addition, various factors can cause PSA level to fluctuate. For example, PSA level often rises due to prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level [3]. Several randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial 1. In the trial, PSA test and DRE were evaluated for their ability to decrease mortality of diagnosed prostate cancer patients. The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease [4]. The aim of the study was to evaluate PSA test accuracy of a clearly defined and screened population with application different statistical indicators. MATERIAL AND METHODS The primary Health Care center in which investigation was carried out serves 97,000 residents of Vilnius city population, including 45 thousand men, of which about 11 thousand are years of age. During the period of information on all screened males (N=8810) was collected, covering 80% of the target population. According to Lithuanian law, PSA screening is offered free of charge to anyone eligible, that comes to the outpatient clinic or family doctor due to the health problem. If test shows PSA level of 3 ng/ml, the subject is directed to onco-urologist for a cascade of procedures (biopsy, treatment and follow up). The 1 main data file with information on screened males, containing variables age, date of testing, PSA level 3 ng/ml (positive) or < 3 ng/ml (negative) was linked with the information at Lithuanian cancer registry and State cause of death registry. In case of new prostate cancer detection, or death from prostate cancer the main data file was updated. Other cancers or other causes of death were interpreted that participating person does not have prostate cancer. Data processing was done using MS excel and IBM SPSS v. 19. Different statistical methods, showing full scale of screening test parameters (accuracy and reliability) was calculated using statistical analysis package Winpepi, starting from sensitivity and specificity of the test, ending with Youden index, positive/negative likelihood/diagnostic Odds ratios and Receiver Operating Characteristic (ROC) curves [5]. RESULTS Lithuanian national programme for early detection of prostate cancer, covered by National Health insurance fund has started in General Practioners in ambulatory care have a duty to inform eligible symptom-free male population (50 to 75 years old for general male populations and 45 to 75 years od age if father or brother had this disease) and propose them to take part in by the use of a PSA test. Above mentioned persons are eligible for free PSA test every two ears. After the test result is available, general practitioner informs patient about the level of PSA. If the level is 3 ng/ml patient is then redirected to oncourologist for additional investigations, which includes DRE, trans-rectal prostate biopsy with the ultrasound control (not less than 6 columns), measuring volume of prostate, histological investigation of the biopsy sample. Also, urologist informs the patient about the results of investigation and gives recommendations for the prevention, and, if cancer of prostate confirmed - official committal for the treatment. All patients, to whom PSA test is < 3 ng/ml, are eligible to repeat the test every 2 years. PSA test, and all cascade of events following a positive test (biopsy, treatment and follow up) are covered by insurance. In the period of , 74.8% of males who actually have prostate cancer were correctly identified by the test. This indicates that 25.2% of screening subjects were wrongly identified as being diseasefree. It s important to mention that sensitivity of PSA test in our study gradually increased from 71.9 in 2008 to 73.8 in 2009, and reached 81 in 2010, showing that 81% of males, who have prostate cancer were 2018/4(83) 111

3 correctly identified by the PSA test. This means, that 19% of subjects have been incorrectly identified as being prostate cancer-free. PSA test specificity parameter shows, that during the three-year period, 90.7% of males who do not have a prostate cancer, were correctly identified by the PSA test. The result indicates, that 9.3% of the subjects without prostate cancer have been wrongly identified as having prostate cancer. Sensitivity parameter showed very small changes in level during each year of the screening (table 1). False positive rate shows, that 9.3 percent of the participants did not have the prostate cancer but the test was positive. False negative rate indicates, that 25.2 percent of participants ad prostate cancer, but the PSA test was negative. Consequently, quarter of participants with false-negative results will be given unfounded reassurance and 9.3% of particpants with falsepositive results might experience unnecessary anxiety and inappropriate treatment. Positive likelihood ratio shoes that during the we have observed an 8.1 increase of the probability of prostate cancer if PSA test was positive. In other words, positive PSA test is about 8,1 times more likely to be made in presence of prostate cancer, than in the absence of it. There was no statistically significant variation of this parameter in time, but positive likelihood in 2010 increased to 9.7 (table1). At the same time negative likelihood ratio is shoes that in there was 0.3 of decrease probability of prostate cancer if PSA test was negative. In other words, if prostate cancer was not present, the likelihood for the negative test was 0.3. Again, in 2010, negative likelihood ratio reached 0.2, showing 0.2 decrease in probability of prostate cancer if PSA test is negative. It s a matter of fact, that unlike sensitivity and specificity, the PPV and NPV are dependent on the population being tested and are influenced by the prevalence of the disease. Diagnostic Odds ratio (DOR) shows, that the odds of obtaining PSA test positive result in prostate cancer patient is 29 times higher, rather than non-diseased person. Consequently, our data shows that in our prostate PSA screening program, discriminatory ability of the test is 29. It must be mentioned, that in 2010, DOR almost doubled and reached 46.4, which showing, that the odds of obtaining test positive result in prostate cancer patient is 46 times higher, rather than non-diseased person. Consequently, the discriminatory ability of PSA test in 2010 was 46. DOR is a global measure that is easy to interpret and does not depend on the prevalence of the prostate cancer, although it must be emphasized that it can vary among groups of patients within severity of their disease. Unfortunately, in our study information on prostate cancer staging was not complete and was not used. Another positive feature of DOR is that DOR correlates with the area under the ROC curve of the test. Furthermore, it can be used for comparisons in meta-analysis. The area under this curve (AUC) represents the overall accuracy of a test, with a value approaching 1.0 indicating a high sensitivity and specificity. Diagonal line represents of zero discrimination (AUC=0.5); (the test is no better than tossing a coin). Our PSA screening test results show, that area under ROC curve is 82.8 percent, statisticaly signifficant, and varies from 80.1 to 85.5 with 95 percent confidence. 1 Table. Main PSA (borderline 3ng/ml) prostate cancer screening test parameters Sensitivity Sensitivity Specificity Specificity False False negative Years Corrected corrected Positive P (95% CI) P (95% CI) P (95% CI) P (95% CI) P (95% CI) P (95% CI) ( ) 69.1 ( ) 90.8 ( ) 87.3 ( ) 9.2 ( ) 28.1 ( ) ( ) 70.8 ( ) 89.7 ( ) 86.0 ( ) 10.3 ( ) 26.2 ( ) ( ) 79.2 ( ) 91.6 ( ) 89.6 ( ) 8.4 ( ) 19.1 ( ) ( ) 72.2 ( ) 90.7 ( ) 87.6 ( ) 9.3 ( ) 25.2 ( ) 1 table continued +Likelihood -Likelihood Diagnostic odds Youden s index Area under Theil s Years ratio Ratio ratio ROC curve coefficient P (95% CI) P (95% CI) P (95% CI) P (95% CI) P (95% CI) P ( ) 0.3 ( ) 25.4 ( ) 0.6 ( ) 81.4 ( ) ( ) 0.3 ( ) 24.5 ( ) 0.6 ( ) 81.7 ( ) ( ) 0.2 ( ) 46.4 ( ) 0.7 ( ) 86.3 ( ) ( ) 0.3 ( ) 29.0 ( ) 0.7 ( ) 82.8 ( ) /4(83)

4 Sensitivity ROC Curve 1 - Specificity Diagonal segments are produced by ties. Picture 1. Receiver Operating Characteristic curve of PSA prostate cancer screening test (borderline 3ng/ml) DISCUSSION In practice, screening tests are never completely accurate. The specificity of a screening test is the ability of that test to exclude those who do not have disease. There will always be a number of falsepositives results (in which the test indicates that subject has the disease, when in reality they do not). False-negative results can also occur (in which the test indicates that there is no disease present, when in reality the subject does have a disease. A good screening test should keep false-positive and false negative results to an absolute minimum. In the ERSPC 2, the sensitivity or ability of the PSA test to detect prostate cancer among men who agreed to biopsy was 71%. In this study, only about one prostate biopsy in four found prostate cancer, and around 15% of men with a normal PSA level (measured as less than 4 ng/ ml) had prostate cancer [6]. Our study (PSA cut-off value of greater than 3 ng/ml) showing, that during the three-year period, 90.7% of males who do not have a prostate cancer was correctly identified by this test. There is a dearth of evidence into how men view their participation in health screening. Our previous study showed that knowledge of men about prostate cancer 2 European Randomized Study of Screening for Prostate Cancer. 2 Table. Area under ROC curve statistical characteristics of PSA prostate cancer screening test AsymptoticSig. b Lower Bound Upper Bound Asymptotic 95% Confidence Interval Area Std. Error a,828,014,000,801,855 a. Under the nonparametric assumption b. Null hypothesis: true area = 0.5 and its prevention was relatively low. Knowledge of the prostate cancer risk factors, clinical symptoms, treatment outcomes and examination possibilities were not dependent on social and demographic characteristics [7]. The main problem with prostate cancer PSA screening is that the biology of this type of cancer is not clearly known. Many years is known, that sufficient fraction from all prostate cancer, especialy in older ages, remain latent without any clinical symptoms [8]. Prostate cancer can be aggressive and life threatening, but can grow so slowly that it might not produce significant symptoms before a man dies from another cause. The treatments may cause unpleasant side effects, such as erectile dysfunction, urinary incontinence, bowel dysfunction or even death. There is no clear benefit in population-based screening when the cancer does not actually pose a risk of death. In Lithuania, after introducing of this screening program incidence increased dramatically. In the period of prostate cancer incidence and mortality are growing, especially during recent years. Signifficant mortality decrease has not been observed, which indirectly shows that national early detection (screening) program is not effective enough [9, 10]. One of possible reasons of this phenomenon is a lack of accessibility to the firstclass treatment for the cases, diagnosed durring the screening. The fact, that for only 25% of the participants of the prgogramme, with PSA >3 ng/ml, prostate biopsies was made [11], indirectly confirming this. Some experts suggest that prostate cancer screening test using PSA has minimal value when it comes to finding prostate cancer, especially in older men. It was noticed, that routine PSA blood tests result in overdiagnosis of prostate cancer, resulting in expensive unnecessary invasive diagnostic procedures, unnecessary treatments, psychosocial harm, related to insignificant prostate cancer tumors [12]. According to the American Cancer Society, There can be different reasons for an elevated PSA level, including prostate cancer, BPH, inflammation, infection, age, and race, all factors that make 2018/4(83) 113

5 PSA test results confusing, leading to potential for unnecessary biopsies, treatment and suffering. Currently, the serum PSA test is the best screening test available for prostate cancer, but unfortunately, the screening per se is increasing the risk of diagnosis of prostate cancer but not sufficiently reducing the risk of dying from this cancer. CONCLUSIONS 1. The typical characteristics of prostate cancer screening PSA test, when cut-of 3ng/ml, was following: The sensitivity of the PSA test is 74.8 ( ), The specificity of the PSA test is 90.7 ( ). 2. False positive rate shows, that 9.3 percent of the participants did not have the prostate cancer but the test was positive. False negative rate indicates that 25.2 percent of the patients had prostate cancer but the test was negative. 3. Quarter of participants with false-negative results will be given unfounded reassurance and 9.3 with false-positive results might experience unnecessary anxiety and inappropriate treatment. 4. Area under ROC curve is 82.8 percent, statisticaly signifficant, and varies from 80.1 to 85.5 with 95 percent confidence. 5. Currently, the serum PSA test is the best screening test available for prostate cancer, but, unfortunately, the screening per se mostly increasing the risk of diagnosis of prostate cancer but not sufficiently reducing the risk of dying from this cancer, which is the main target of any cancer screening. Straipsnis gautas , priimtas References 1. Boyle PO. Brawley Prostate Cancer: Current Evidence Weighs Against Population Screening, CA. A Cancer Journal for Clinicians. July/August 2009;59(4): Tiffany O Callaghan Prostate cancer test has been misused for money. New Scientist. 17 February 2014; Greene KL, Albertsen PC, Babaian RJ, et al. Prostate specific antigen best practice statement: 2009 update. J Urol. 2009;182: Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine. 2004; 350(22): Abramson JH. WINPEPI updated: Computer programs for epidemiologists, and their teaching potential. Epidemiologic Perspectives and Innovations. 2011;8:1. DOI: / Andriole GL, Crawford ED, Grubb RL, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of followup. Journal of the National Cancer Institute. 2012;104(2): Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostatecancer mortality in a randomized European study. New England Journal of Medicine. 2009;360(13): Šturienė R, Kalibatienė D, Gurevičius R. The relationship between men s knowledge on prostate cancer, it s prevention and the socialdemographical characteristics. Public Health. 2012;1(56):62-72 (in lithuanian). 9. Gurevičius R, Lazutka V. Incidence and future prediction of prostate cancer in Lithuania in m. Onkologija-5, Mokslas. A. Telyčėnas, Edt. 1983; ISSN (in lithuanian). 10. Čepanauskienė R, Gurevičius R. Incidence and mortality from prostate cancer in Lithuania before PSA Era and after. Public Health. 2009;1(44):19-25 (in lithuanian). 11. Source from internet: Valstybinė ligonių kasa prie Sveikatos apsaugos ministerijos. < [accessed ]. 12. Source from internet: < factsheet/detection/psa> /4(83)

6 PSA testo tikslumas Lietuvos prostatos vėžio organizuotos patikros programos metu Romualdas Gurevičius 1, Renata Šturienė 2, Arvydas Šilys 3 1 Higienos institutas, 2 VšĮ Šeškinės poliklinika, 3 Vilniaus universiteto klinika Santrauka Priešinės liaukos vėžio ankstyvosios diagnostikos programa (toliau Programa) Lietuvoje pradėta vykdyti 2006 m. Šiuo metu Programa skirta vyrams nuo 50 iki 69 metų ir vyrams nuo 45 metų, jeigu jų tėvai ar broliai sirgo prostatos vėžiu. Programos tikslinės grupės vyrams gali būti atliekamas kraujo tyrimas, parodantis prostatos specifinio antigeno (toliau PSA) koncentraciją kraujyje. Jei PSA kiekis yra 3 ng/ml, šeimos gydytojas išduoda siuntimą konsultuotis su urologu, o šis prireikus atlieka tikslesnį tyrimą prostatos biopsiją. Tyrimo tikslas. Nustatyti ir įvertinti PSA testo tikslumą atlikus apibrėžtos populiacijos, dalyvausios organizuotoje patikroje, ištisinį tyrimą. Tyrimo medžiaga ir metodai. Poliklinika, kurioje atliekamas tyrimas, aptarnauja Vilniaus miesto gyventojų, tarp jų 45 tūkstančiai vyrų, iš jų apie 11 tūkstančių yra metų amžiaus m. laikotarpiu buvo surinkta informacija apie visus patikrintus vyrus (N = 8 810), apimanti 80 proc. tikslinės populiacijos. Duomenų statistiniam apdorojimui taikyti įvairiausi, dažnai vienas kitą papildantys metodai, skaičiuota naudojantis Winpepi ver Rezultatai ir išvados. Mūsų tyrime PSA tyrimo jautrumas buvo 74,8 proc. (95 proc. PI 70 79,1), PSA tyrimo specifiškumas 90,7 proc. (95 proc. PI 90,1 91,3). Klaidingai teigiamos diagnozės tikimybė parodė, jog 9,3 proc. mūsų tyrimo dalyvių nesirgo prostatos vėžiu, tačiau testas buvo teigiamas. Klaidingai neigiamos diagnozės tikimybė parodė, jog 25,2 proc. mūsų turimo dalyvių sirgo prostatos vėžiu, nors testas buvo neigiamas. Todėl ketvirtis programos dalyvių, kurių buvo klaidingai neigiami rezultatai, gavo nepagrįstas garantijas, kad jie sveiki, o 9,3 proc. dalyvių, kurių rezultatai buvo klaidingai teigiami, galėjo patirti nereikalingą nerimą ir gauti netinkamą gydymą. Tyrimo rezultatai parodė, jog ROC kreivės plotas buvo 82,8 proc. (95 proc. PI 80,1 85,5), statistiškai reikšmingas. Visa tai rodo problemas, susijusias su pacientų nerimu ir (ar) bereikalingai atliktu radikaliu gydymu, todėl pacientams turėtų būti paaiškintos teigiamos ir neigiamos tokių patikrų pasekmės. Organizuotos prostatos vėžio patikros šalyje rezultatai kol kas rodo tik didėjantį sergamumą ir labai nežymiai mažėjantį mirtingumą. Tai gali priklausyti nuo įvairių priežasčių. Vis dėlto tai, kad tik ketvirtadaliui ištirtų asmenų, kurių PSA testas viršijo ribinį lygį, atliktos biopsijos, rodo, jog 75 proc. patikros dalyvių net nebuvo bandyta patvirtinti / atmesti diagnozę ir, suprantama, kvalifikuotai gydyti. Reikšminiai žodžiai: prostatos vėžys, organizuota patikra, PSA, jautrumas, specifiškumas. Adresas susirašinėti: Romualdas Gurevičius Higienos instituto Sveikatos informacijos centras Didžioji g. 22, Vilnius El. p. romualdas.gurevicius@hi.lt Received 14 November 2018, accepted 15 December /4(83) 115

Prostate-Specific Antigen (PSA) Test

Prostate-Specific Antigen (PSA) Test Prostate-Specific Antigen (PSA) Test What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the

More information

Questions and Answers About the Prostate-Specific Antigen (PSA) Test

Questions and Answers About the Prostate-Specific Antigen (PSA) Test 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 Questions and Answers

More information

PSA Screening and Prostate Cancer. Rishi Modh, MD

PSA Screening and Prostate Cancer. Rishi Modh, MD PSA Screening and Prostate Cancer Rishi Modh, MD ABOUT ME From Tampa Bay Went to Berkeley Prep University of Miami for Undergraduate - 4 years University of Miami for Medical School - 4 Years University

More information

Urological Society of Australia and New Zealand PSA Testing Policy 2009

Urological Society of Australia and New Zealand PSA Testing Policy 2009 Executive summary Urological Society of Australia and New Zealand PSA Testing Policy 2009 1. Prostate cancer is a major health problem and is the second leading cause of male cancer deaths in Australia

More information

10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION

10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION Lenette Walters, MS, MT(ASCP) Medical Affairs Manager Beckman Coulter, Inc. *phi is a calculation using the values from PSA, fpsa and p2psa

More information

Annual Report on Prostate Diseases

Annual Report on Prostate Diseases An except from the HMS 2010 Annual Report on Prostate Diseases. To purchase the full report, visit www.health.harvard.edu/special_health_reports/prostate_disease Harvard Medical School 2010 Annual Report

More information

Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement

Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement Clinical Review & Education JAMA US Preventive Services Task Force RECOMMENDATION STATEMENT Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement US Preventive Services

More information

Prostate cancer screening: Attitudes and practices of family physicians in Ontario

Prostate cancer screening: Attitudes and practices of family physicians in Ontario Original research Prostate cancer screening: Attitudes and practices of family physicians in Ontario Christopher B. Allard, MD; * Shawn Dason; * Janis Lusis, MD; Anil Kapoor, MD, FRCSC * *McMaster Institute

More information

The Evolving Role of PSA for Prostate Cancer. The Evolving Role of PSA for Prostate Cancer: 10/30/2017

The Evolving Role of PSA for Prostate Cancer. The Evolving Role of PSA for Prostate Cancer: 10/30/2017 The Evolving Role of PSA for Prostate Cancer Adele Marie Caruso, DNP, CRNP Adult Nurse Practitioner Perelman School of Medicine at the University of Pennsylvania November 4, 2017 The Evolving Role of PSA

More information

PSA screening. To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine

PSA screening. To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine PSA screening To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine Conflict of Interest Declaration: Nothing to Disclose

More information

Screening for Prostate Cancer with the Prostate Specific Antigen (PSA) Test: Recommendations 2014

Screening for Prostate Cancer with the Prostate Specific Antigen (PSA) Test: Recommendations 2014 Screening for Prostate Cancer with the Prostate Specific Antigen (PSA) Test: Recommendations 2014 Canadian Task Force on Preventive Health Care October 2014 Putting Prevention into Practice Canadian Task

More information

Prostate Cancer. Biomedical Engineering for Global Health. Lecture Fourteen. Early Detection. Prostate Cancer: Statistics

Prostate Cancer. Biomedical Engineering for Global Health. Lecture Fourteen. Early Detection. Prostate Cancer: Statistics Biomedical Engineering for Global Health Lecture Fourteen Prostate Cancer Early Detection Prostate Cancer: Statistics Prostate gland contributes enzymes, nutrients and other secretions to semen. United

More information

Pre-test. Prostate Cancer The Good News: Prostate Cancer Screening 2012: Putting the PSA Controversy to Rest

Pre-test. Prostate Cancer The Good News: Prostate Cancer Screening 2012: Putting the PSA Controversy to Rest Pre-test Matthew R. Cooperberg, MD, MPH UCSF 40 th Annual Advances in Internal Medicine Prostate Cancer Screening 2012: Putting the PSA Controversy to Rest 1. I do not offer routine PSA screening, and

More information

Clinical Policy Title: Prostate-specific antigen screening

Clinical Policy Title: Prostate-specific antigen screening Clinical Policy Title: Prostate-specific antigen screening Clinical Policy Number: 13.01.06 Effective Date: May 1, 2017 Initial Review Date: April 19, 2017 Most Recent Review Date: April 19, 2017 Next

More information

Epidemiology of burns in Lithuania during

Epidemiology of burns in Lithuania during 541 Epidemiology of burns in Lithuania during 1991 2004 Department of Plastic and Reconstructive Surgery, Kaunas University of Medicine, Lithuania Key words: burns; epidemiology; Lithuania. Summary. The

More information

Prostate Cancer Screening: Risks and Benefits across the Ages

Prostate Cancer Screening: Risks and Benefits across the Ages Prostate Cancer Screening: Risks and Benefits across the Ages 7 th Annual Symposium on Men s Health Continuing Progress: New Gains, New Challenges June 10, 2009 Michael J. Barry, MD General Medicine Unit

More information

Prostate Cancer Screening (PDQ )

Prostate Cancer Screening (PDQ ) 1 di 7 03/04/2017 12.22 NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute

More information

Applying the Principles of Disease Screening to Prostate Cancer

Applying the Principles of Disease Screening to Prostate Cancer PUBLIC HEALTH Applying the Principles of Disease Screening to Prostate Cancer Maria Paiva, BSP, PharmD, BCPS 1,2 Mary H. H. Ensom, B. Sc. (Pharm), PharmD, FASHP, FCCP, FCSHP, FCAHS 1,3 1 Faculty of Pharmaceutical

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... 1 Coding/Billing Information... 12 References...

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/Science in Nursing Scholarly Projects Nursing 5-2012 Examining the Efficacy of Screening with Prostate- Specific Antigen Testing in Reducing Prostate Cancer

More information

Questionnaire. 1) Do you see men over the age of 40? 1. Yes 2. No

Questionnaire. 1) Do you see men over the age of 40? 1. Yes 2. No Questionnaire 1) Do you see men over the age of 40? 1. Yes 2. No 2) In what state do you practice? (drop-down menu of 50 states and District of Columbia) 3) What is your medical specialty? (Please select

More information

Prostate Biopsy. Prostate Biopsy. We canʼt go backwards: Screening has helped!

Prostate Biopsy. Prostate Biopsy. We canʼt go backwards: Screening has helped! We canʼt go backwards: Screening has helped! Robert E. Donohue M.D. Denver V.A. Medical Center University of Colorado Prostate Biopsy Is cure necessary; when it is possible? Is cure possible; when it is

More information

PSA & Prostate Cancer Screening

PSA & Prostate Cancer Screening PSA & Prostate Cancer Screening DR JONATHAN REES MD MRCS MRCGP When a thing ceases to be a subject of controversy, it ceases to be a subject of interest Do you think we should have a national screening

More information

Prostate Cancer Screening. Eric Shreve, MD Bend Urology Associates

Prostate Cancer Screening. Eric Shreve, MD Bend Urology Associates Prostate Cancer Screening Eric Shreve, MD Bend Urology Associates University of Cincinnati Medical Center University of Iowa Hospitals and Clinics PSA Human kallikrein 3 Semenogelin is substrate Concentration

More information

PSA To screen or not to screen? Darrel Drachenberg, MD, FRCSC

PSA To screen or not to screen? Darrel Drachenberg, MD, FRCSC PSA To screen or not to screen? Darrel Drachenberg, MD, FRCSC Disclosures Faculty / Speaker s name: Darrel Drachenberg Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria:

More information

Page 1. Selected Controversies. Cancer Screening! Selected Controversies. Breast Cancer Screening. ! Using Best Evidence to Guide Practice!

Page 1. Selected Controversies. Cancer Screening! Selected Controversies. Breast Cancer Screening. ! Using Best Evidence to Guide Practice! Cancer Screening!! Using Best Evidence to Guide Practice! Judith M.E. Walsh, MD, MPH! Division of General Internal Medicine! Womenʼs Health Center of Excellence University of California, San Francisco!

More information

Elevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017

Elevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Elevated PSA Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Issues we will cover today.. The measurement of PSA,

More information

Prostate-Specific Antigen (PSA) Screening for Prostate Cancer

Prostate-Specific Antigen (PSA) Screening for Prostate Cancer Medical Coverage Policy Effective Date... 4/15/2018 Next Review Date... 4/15/2019 Coverage Policy Number... 0215 Prostate-Specific Antigen (PSA) Screening for Prostate Cancer Table of Contents Related

More information

Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH

Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH 1 de 32 04-05-2013 19:24 Official reprint from UpToDate www.uptodate.com 2013 UpToDate Author Richard M Hoffman, MD, MPH Disclosures Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH

More information

Otis W. Brawley, MD, MACP, FASCO, FACE

Otis W. Brawley, MD, MACP, FASCO, FACE Otis W. Brawley, MD, MACP, FASCO, FACE Chief Medical and Scientific Officer American Cancer Society Professor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University Atlanta, Georgia

More information

Overview. What is Cancer? Prostate Cancer 3/2/2014. Davis A Romney, MD Ironwood Cancer and Research Centers Feb 18, 2014

Overview. What is Cancer? Prostate Cancer 3/2/2014. Davis A Romney, MD Ironwood Cancer and Research Centers Feb 18, 2014 Prostate Cancer Davis A Romney, MD Ironwood Cancer and Research Centers Feb 18, 2014 Overview Start with the basics: Definition of cancer Most common cancers in men Prostate, lung, and colon cancers Cancer

More information

Vilnius high school students knowledge of cervical cancer risk factors

Vilnius high school students knowledge of cervical cancer risk factors ACTA MEDICA LITUANICA. 2007. Vilnius Vol. high 14. school No. 4. students P. 291 296 knowledge of cervical cancer risk factors 291 Lietuvos mokslų akademija, 2007 Lietuvos mokslų akademijos leidykla, 2007

More information

The study of cancer patients distress

The study of cancer patients distress ACTA MEDICA LITUANICA. 2014. Vol. 21. No. 2. P. 51 56 Lietuvos mokslų akademija, 2014 The Second International Conference on Psychosocial Oncology Psychosocial Support and Communication in Cancer Care:

More information

Screening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality

Screening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality Screening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality Sanoj Punnen, MD, MAS Assistant Professor of Urologic Oncology University of Miami, Miller School of Medicine and Sylvester

More information

Shared Decision Making in Breast and Prostate Cancer Screening. An Update and a Patient-Centered Approach. Sharon K. Hull, MD, MPH July, 2017

Shared Decision Making in Breast and Prostate Cancer Screening. An Update and a Patient-Centered Approach. Sharon K. Hull, MD, MPH July, 2017 Shared Decision Making in Breast and Prostate Cancer Screening An Update and a Patient-Centered Approach Sharon K. Hull, MD, MPH July, 2017 Overview Epidemiology of Breast and Prostate Cancer Controversies

More information

PSA & Prostate Cancer Screening

PSA & Prostate Cancer Screening PSA & Prostate Cancer Screening DR JONATHAN REES MD MRCS MRCGP Do you think we should have a national screening programme for Prostate Cancer using PSA? YES it s an outrage, women have breast cancer screening

More information

Questions and Answers about Prostate Cancer Screening with the Prostate-Specific Antigen Test

Questions and Answers about Prostate Cancer Screening with the Prostate-Specific Antigen Test Questions and Answers about Prostate Cancer Screening with the Prostate-Specific Antigen Test About Cancer Care Ontario s recommendations for prostate-specific antigen (PSA) screening 1. What does Cancer

More information

Cancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject:

Cancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject: Subject: Saturation Biopsy for Diagnosis, Last Review Status/Date: September 2016 Page: 1 of 9 Saturation Biopsy for Diagnosis, Description Saturation biopsy of the prostate, in which more cores are obtained

More information

Fellow GU Lecture Series, Prostate Cancer. Asit Paul, MD, PhD 02/20/2018

Fellow GU Lecture Series, Prostate Cancer. Asit Paul, MD, PhD 02/20/2018 Fellow GU Lecture Series, 2018 Prostate Cancer Asit Paul, MD, PhD 02/20/2018 Disease Burden Screening Risk assessment Treatment Global Burden of Prostate Cancer Prostate cancer ranked 13 th among cancer

More information

Your Guide to Prostate Cancer

Your Guide to Prostate Cancer Your Guide to Prostate Cancer If you face a diagnosis of prostate cancer, what s next? We can help. A prostate cancer diagnosis can be overwhelming. The good news is that while prostate cancer can be serious,

More information

To be covered. Screening, early diagnosis, and treatment including Active Surveillance for prostate cancer: where is Europe heading for?

To be covered. Screening, early diagnosis, and treatment including Active Surveillance for prostate cancer: where is Europe heading for? To be covered Screening, early diagnosis, and treatment including Active Surveillance for prostate cancer: where is Europe heading for? Europa Uomo meeting Stockholm 29 Chris H.Bangma Rotterdam, The Netherlands

More information

Increasing attendance in a cervical cancer screening programme by personal invitation: experience of a Lithuanian primary health care centre

Increasing attendance in a cervical cancer screening programme by personal invitation: experience of a Lithuanian primary health care centre ACTA MEDICA LITUANICA. 2016. Vol. 23. No. 3. P. 180 184 Lietuvos mokslų akademija, 2016 Increasing attendance in a cervical cancer screening programme by personal invitation: experience of a Lithuanian

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

The need for orthodontic treatment among and year-old Lithuanian schoolchildren

The need for orthodontic treatment among and year-old Lithuanian schoolchildren 814 The need for orthodontic treatment among 10 11- and 14 15-year-old Lithuanian schoolchildren Diana Baubinienė, Antanas Šidlauskas, Irena Misevičienė 1 Department of Orthodontics, 1 Institute for Biomedical

More information

Contact: Linda Aagard Huntsman Cancer Institute

Contact: Linda Aagard Huntsman Cancer Institute Contact: Linda Aagard Huntsman Cancer Institute 801-587-7639 linda.aagard@hci.utah.edu U.S. Cancer Screening Trial Reports More Diagnoses, but No Fewer Deaths from Annual Prostate Cancer Screening Huntsman

More information

Prostatos vėžys: samprata apie riziką. Ramūnas Mickevičius Urologijos klinika LSMU KK Druskininkai

Prostatos vėžys: samprata apie riziką. Ramūnas Mickevičius Urologijos klinika LSMU KK Druskininkai Prostatos vėžys: samprata apie riziką Ramūnas Mickevičius Urologijos klinika LSMU KK Druskininkai 2014-01-31 02-01 Terminas PROSTATOS VĖŽYS pacientui kelia nerimą, įtampą, baimę mirčiai. Kas metai Lietuvoje

More information

The Debate: Is screening s effect on mortality significant? Cancer incidence/death/ gender US

The Debate: Is screening s effect on mortality significant? Cancer incidence/death/ gender US WHAT IS CANCER? 1) A neoplastic Dz with a fatal natural outcome. 2) A cellular abnormality. which grows rapidly causing death. 3).. which grows slowly. 4). which stops growing. 5). which regresses. -Welch

More information

Prostate Cancer Screening: Con. Laurence Klotz Professor of Surgery, Sunnybrook HSC University of Toronto

Prostate Cancer Screening: Con. Laurence Klotz Professor of Surgery, Sunnybrook HSC University of Toronto Prostate Cancer Screening: Con Laurence Klotz Professor of Surgery, Sunnybrook HSC University of Toronto / Why not PSA screening? Overdiagnosis Overtreatment Risk benefit ratio unfavorable Flaws of PSA

More information

Mr PHIP No. 1 Prostate cancer: Should I be tested?

Mr PHIP No. 1 Prostate cancer: Should I be tested? Mr PHIP No. 1 cancer: Should I be tested? Having a large prostate doesn t increase your chances of having prostate cancer. No. 1 / 1 Key points cancer is the most common male cancer after skin cancer.

More information

Prostate Cancer. What Are the Risk Factors? Prostate cancer is the second leading cancer that causes death to men in the U.S.

Prostate Cancer. What Are the Risk Factors? Prostate cancer is the second leading cancer that causes death to men in the U.S. Prostate cancer is the second leading cancer that causes death to men in the U.S. What Are the Risk Factors? Prostate cancer is unusual because it does not behave the same way in all men. Sometimes the

More information

Quality-of-Life Effects of Prostate-Specific Antigen Screening

Quality-of-Life Effects of Prostate-Specific Antigen Screening Quality-of-Life Effects of Prostate-Specific Antigen Screening Eveline A.M. Heijnsdijk, Ph.D., Elisabeth M. Wever, M.Sc., Anssi Auvinen, M.D., Jonas Hugosson, M.D., Stefano Ciatto, M.D., Vera Nelen, M.D.,

More information

Transition zone volume measurement is it useful before surgery for benign prostatic hyperplasia?

Transition zone volume measurement is it useful before surgery for benign prostatic hyperplasia? 792 Transition zone volume measurement is it useful before surgery for benign prostatic hyperplasia? Department of Urology, Kaunas University of Medicine, Lithuania Key words: benign prostatic hyperplasia;

More information

Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter?

Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter? ORIGINAL ARTICLE Gulhane Med J 2018;60: 14-18 Gülhane Faculty of Medicine 2018 doi: 10.26657/gulhane.00010 Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate

More information

Clinical characteristics and long-term outcomes of 35 patients with Wegener s granulomatosis followed up at two rheumatology centers in Lithuania

Clinical characteristics and long-term outcomes of 35 patients with Wegener s granulomatosis followed up at two rheumatology centers in Lithuania 256 Medicina (Kaunas) 2010;46(4):256-60 Clinical characteristics and long-term outcomes of 35 patients with Wegener s granulomatosis followed up at two rheumatology centers in Lithuania Jolanta Dadonienė

More information

An educational guide from Genomic Health

An educational guide from Genomic Health Active Surveillance or Immediate Treatment? The Oncotype DX Prostate Cancer Assay helps you and your doctor choose with confidence. For more information, visit OncotypeDX.com. An educational guide from

More information

Prostate Cancer Screening Guidelines in 2017

Prostate Cancer Screening Guidelines in 2017 Prostate Cancer Screening Guidelines in 2017 Pocharapong Jenjitranant, M.D. Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital Prostate Specific Antigen (PSA) Prostate

More information

Prostate Cancer: from Beginning to End

Prostate Cancer: from Beginning to End Prostate Cancer: from Beginning to End Matthew D. Katz, M.D. Assistant Professor Urologic Oncology Robotic and Laparoscopic Surgery University of Arkansas for Medical Sciences Winthrop P. Rockefeller Cancer

More information

EAU 2009: US Study Shows No Mortality Benefit From Prostate Cancer Screening, But European Study Suggests There May Be One

EAU 2009: US Study Shows No Mortality Benefit From Prostate Cancer Screening, But European Study Suggests There May Be One From Medscape Medical News : www.medscape.com/viewarticle/589786 EAU 2009: US Study Shows No Mortality Benefit From Prostate Cancer Screening, But European Study Suggests There May Be One By Roxanne Nelson

More information

#1 cancer. #2 killer. Boulder has higher rate of prostate cancer compared to other areas surrounding Rocky Flats

#1 cancer. #2 killer. Boulder has higher rate of prostate cancer compared to other areas surrounding Rocky Flats Prostate cancer is a VERY COMMON DISEASE BREAKTHROUGHS IN THE DETECTION OF PROSTATE CANCER Carolyn M. Fronczak M.D., M.S.P.H. Urologic Surgery 303-647-9129 #1 cancer #2 killer Ca Cancer J Clin 2018;68:7

More information

Let s look a minute at the evidence supporting current cancer screening recommendations.

Let s look a minute at the evidence supporting current cancer screening recommendations. I m Dr. Therese Bevers, Medical Director of the Cancer Prevention Center and Professor of Clinical Cancer Prevention at The University of Texas MD Anderson Cancer Center. Today s lecture is on screening

More information

Mercy s Cancer Program 2014 Update

Mercy s Cancer Program 2014 Update Mercy s Cancer Program 2014 Update Mercy Hospital & Medical Center is accredited Academic Comprehensive Cancer Program by the American College of Surgeon s Commission on Cancer. This study is directed

More information

USA Preventive Services Task Force PSA Screening Recommendations- May 2018

USA Preventive Services Task Force PSA Screening Recommendations- May 2018 GPGU - NOTÍCIAS USA Preventive Services Task Force PSA Screening Recommendations- May 2018 Rationale Importance Prostate cancer is one of the most common types of cancer that affects men. In the United

More information

Contemporary Approaches to Screening for Prostate Cancer

Contemporary Approaches to Screening for Prostate Cancer Contemporary Approaches to Screening for Prostate Cancer Gerald L. Andriole, MD Robert K. Royce Distinguished Professor Chief of Urologic Surgery Siteman Cancer Center Washington University School of Medicine

More information

4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% < >80 Current Age (Yrs)

4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% < >80 Current Age (Yrs) Biomedical Engineering for Global Health Lecture Twelve Prostate Cancer Early Detection Prostate Cancer: Statistics Prostate gland contributes enzymes, nutrients and other secretions to semen. United States:

More information

Cancer Screening: Evidence, Opinion and Fact Dialogue on Cancer April Ruth Etzioni Fred Hutchinson Cancer Research Center

Cancer Screening: Evidence, Opinion and Fact Dialogue on Cancer April Ruth Etzioni Fred Hutchinson Cancer Research Center Cancer Screening: Evidence, Opinion and Fact Dialogue on Cancer April 2018? Ruth Etzioni Fred Hutchinson Cancer Research Center Three thoughts to begin 1. Cancer screening is a good idea in principle Detect

More information

PROSTATE CANCER Amit Gupta MD MPH

PROSTATE CANCER Amit Gupta MD MPH PROSTATE CANCER Amit Gupta MD MPH Depts. of Urology and Epidemiology Amit-Gupta-1@uiowa.edu dramitgupta@gmail.com Tel: 319-384-5251 OUTLINE PSA screening controversy How to use PSA more effectively Treatment

More information

Sensitivity, specicity, ROC

Sensitivity, specicity, ROC Sensitivity, specicity, ROC Thomas Alexander Gerds Department of Biostatistics, University of Copenhagen 1 / 53 Epilog: disease prevalence The prevalence is the proportion of cases in the population today.

More information

Influence of enteral nutrition on the frequency of complications in case of major burns

Influence of enteral nutrition on the frequency of complications in case of major burns 957 Influence of enteral nutrition on the frequency of complications in case of major burns Daiva Gudavičienė, Rytis Rimdeika, Kęstutis Adamonis 1 Division of Plastic Surgery and Burns, 1 Clinic of Gastroenterology,

More information

The Challenge of Cancer Screening Part One Prostate Cancer and Lung Cancer Screening

The Challenge of Cancer Screening Part One Prostate Cancer and Lung Cancer Screening The Challenge of Cancer Screening Part One Prostate Cancer and Lung Cancer Screening The Challenge of Cancer Screening Part One Prostate Cancer and Lung Cancer Screening By Marsha Fountain, RN, MSN The

More information

SHARED DECISION MAKING FOR PROSTATE CANCER SCREENING

SHARED DECISION MAKING FOR PROSTATE CANCER SCREENING SHARED DECISION MAKING FOR PROSTATE CANCER SCREENING 16 TH A N N U A L M A S S A C H U S E T T S P R O S T A T E C A N C E R S Y M P O S I U M Mary McNaughton-Collins, MD, MPH Foundation Medical Director

More information

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1.

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1. NIH Public Access Author Manuscript Published in final edited form as: World J Urol. 2011 February ; 29(1): 11 14. doi:10.1007/s00345-010-0625-4. Significance of preoperative PSA velocity in men with low

More information

GERONTOLOGIJA. Original articles. E. Mišeikytė Kaubrienė, M. Trakymas, A. Ulys

GERONTOLOGIJA. Original articles. E. Mišeikytė Kaubrienė, M. Trakymas, A. Ulys Gerontologija 2008; 9(2): 79 85 GERONTOLOGIJA Original articles Recurrence of differentiated thyroid cancer: significance of ultrasound examination and ultrasound-guided fine-needle aspiration biopsy in

More information

Prostate Cancer Incidence

Prostate Cancer Incidence Prostate Cancer: Prevention, Screening and Treatment Philip Kantoff MD Dana-Farber Cancer Institute Professor of fmedicine i Harvard Medical School Prostate Cancer Incidence # of patients 350,000 New Cases

More information

PROSTATE CANCER SCREENING: AN UPDATE

PROSTATE CANCER SCREENING: AN UPDATE PROSTATE CANCER SCREENING: AN UPDATE William G. Nelson, M.D., Ph.D. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins American Association for Cancer Research William G. Nelson, M.D., Ph.D. Disclosures

More information

Translating Evidence Into Policy The Case of Prostate Cancer Screening. Ruth Etzioni Fred Hutchinson Cancer Research Center

Translating Evidence Into Policy The Case of Prostate Cancer Screening. Ruth Etzioni Fred Hutchinson Cancer Research Center Translating Evidence Into Policy The Case of Prostate Cancer Screening Ruth Etzioni Fred Hutchinson Cancer Research Center Prostate Cancer Mortality in the US 2011 Prostate Cancer Mortality in the US 2011

More information

Controversies in Prostate Cancer Screening

Controversies in Prostate Cancer Screening Controversies in Prostate Cancer Screening William J Catalona, MD Northwestern University Chicago Disclosure: Beckman Coulter, a manufacturer of PSA assays, provides research support PSA Screening Recommendations

More information

Resolving the PSA testing controversy. Professor Villis Marshall AC Professor Bruce Armstrong AM Professor Mark Frydenberg

Resolving the PSA testing controversy. Professor Villis Marshall AC Professor Bruce Armstrong AM Professor Mark Frydenberg Resolving the PSA testing controversy Professor Villis Marshall AC Professor Bruce Armstrong AM Professor Mark Frydenberg Professor Villis Marshall AC Introduc)on Guidelines aim to inform tes)ng for the

More information

Original Article. Introduction. Xin LIU 1, *Jie TANG 2, Xiang FEI 2, Qiu-Yang LI 2

Original Article. Introduction. Xin LIU 1, *Jie TANG 2, Xiang FEI 2, Qiu-Yang LI 2 Original Article Prostate-specific Antigen (PSA) Density and Free to Total PSA Ratio in Diagnosing Prostate Cancer with Prostate-Specific Antigen Levels of 4.0 ng/ml or Less Xin LIU 1, *Jie TANG 2, Xiang

More information

Prostate cancer screening: a wobble Balance. Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph

Prostate cancer screening: a wobble Balance. Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph Prostate cancer screening: a wobble Balance Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph Epidemiology Most common non skin malignancy in men in developed countries Third leading

More information

J Clin Oncol 25: by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 25: by American Society of Clinical Oncology INTRODUCTION VOLUME 25 NUMBER 21 JULY 20 2007 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Prediction of Prostate Cancer for Patients Receiving Finasteride: Results From the Prostate Cancer Prevention Trial

More information

The importance of T-lymphocyte subsets on overall survival of colorectal and gastric cancer patients

The importance of T-lymphocyte subsets on overall survival of colorectal and gastric cancer patients 548 The importance of T-lymphocyte subsets on overall survival of colorectal and gastric cancer patients Vida Milašienė, Eugenijus Stratilatovas 1, Violeta Norkienė Laboratory of Experimental Oncology,

More information

Screening for Disease

Screening for Disease Screening for Disease An Ounce of Prevention is Worth a Pound of Cure. Actually, an ounce of prevention is better than a pound of cure, but if prevention hasn t been effective, perhaps early identification

More information

A senior s guide for preventative healthcare services Ynolde F. Smith D.O.

A senior s guide for preventative healthcare services Ynolde F. Smith D.O. A senior s guide for preventative healthcare services Ynolde F. Smith D.O. What can we do to prevent disease? Exercise Eating Well Keep a healthy weight Injury prevention Mental Health Social issues (care

More information

CLINICAL INVESTIGATIONS

CLINICAL INVESTIGATIONS CLINICAL INVESTIGATIONS 147 Medicina (Kaunas) 211;47(3):147-53 Frequent Methylation of RASSF1 and RARB in Urine Sediments From Patients with Early Stage Prostate Cancer Kristina Daniūnaitė 1, Artūras Berezniakovas

More information

Horizon Scanning Technology Briefing. Prostate cancer gene 3 (Progensa PCA3) assay in the diagnosis of prostate cancer

Horizon Scanning Technology Briefing. Prostate cancer gene 3 (Progensa PCA3) assay in the diagnosis of prostate cancer Horizon Scanning Technology Briefing National Horizon Scanning Centre Prostate cancer gene 3 (Progensa PCA3) assay in the diagnosis of prostate cancer December 2006 This technology summary is based on

More information

Where are we with PSA screening?

Where are we with PSA screening? Where are we with PSA screening? Faculty/Presenter Disclosure Rela%onships with commercial interests: None Disclosure of Commercial Support This program has received no financial support. This program

More information

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program ORIGINAL ARTICLE Vol. 40 (6): 745-752, November - December, 2014 doi: 10.1590/S1677-5538.IBJU.2014.06.05 Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up

More information

Prostate Cancer Testing. Don t be caught out

Prostate Cancer Testing. Don t be caught out Prostate Cancer Testing Don t be caught out Prostate cancer testing What is Prostate Cancer? It is cancer of the prostate, a walnut-sized gland inside the body located in front of the urinary bladder in

More information

ROC Curves. I wrote, from SAS, the relevant data to a plain text file which I imported to SPSS. The ROC analysis was conducted this way:

ROC Curves. I wrote, from SAS, the relevant data to a plain text file which I imported to SPSS. The ROC analysis was conducted this way: ROC Curves We developed a method to make diagnoses of anxiety using criteria provided by Phillip. Would it also be possible to make such diagnoses based on a much more simple scheme, a simple cutoff point

More information

The prevalence and risk factors of low-energy fractures among postmenopausal women with osteoporosis in Belarus

The prevalence and risk factors of low-energy fractures among postmenopausal women with osteoporosis in Belarus Gerontologija 2014; 15(3): 143 147 GERONTOLOGIJA Original article The prevalence and risk factors of low-energy fractures among postmenopausal women with osteoporosis in Belarus Ema Rudenka 1, Natalya

More information

Analysis of prognostic factors for melanoma patients

Analysis of prognostic factors for melanoma patients ACTA MEDICA LITUANICA. 2017. Vol. 24. No. 1. P. 25 34 Lietuvos mokslų akademija, 2017 Analysis of prognostic factors for melanoma patients Andrė Lideikaitė 1, Julija Mozūraitienė 2, Simona Letautienė 1,

More information

The U.S. Preventive Services Task Force (USPSTF) makes

The U.S. Preventive Services Task Force (USPSTF) makes Annals of Internal Medicine Clinical Guideline Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services

More information

Prostate cancer smart screening, precision diagnosis, personalised treatment'

Prostate cancer smart screening, precision diagnosis, personalised treatment' Prostate cancer smart screening, precision diagnosis, personalised treatment' Prof. Hashim Ahmed PhD, FRCS(Urol), BM, BCh (Oxon), BA(Hons) Consultant Urological Surgeon Bupa Cromwell Hospital Clinics:

More information

Prostate Cancer Screening Where are we? Prof. Bob Steele Professor of Surgery, University of Dundee Independent Chair, UK NSC

Prostate Cancer Screening Where are we? Prof. Bob Steele Professor of Surgery, University of Dundee Independent Chair, UK NSC Prostate Cancer Screening Where are we? Prof. Bob Steele Professor of Surgery, University of Dundee Independent Chair, UK NSC 1990 Screening The detection of disease in asymptomatic people in order to

More information

LESSON 5.2 WORKBOOK. What do cancer screens really tell us? Workbook Lesson 5.2

LESSON 5.2 WORKBOOK. What do cancer screens really tell us? Workbook Lesson 5.2 Mortality rate The rate at which people die from a specific cancer. For a complete list of defined terms, see the Glossary. LESSON 5.2 WORKBOOK What do cancer screens really tell us? Treating cancer successfully

More information

U.S. Preventive Services Task Force: Draft Prostate Cancer Screening Recommendation (April 2017)

U.S. Preventive Services Task Force: Draft Prostate Cancer Screening Recommendation (April 2017) 1 U.S. Preventive Services Task Force: Draft Prostate Cancer Screening Recommendation (April 2017) Alex Krist MD MPH Professor and Director of Research Department of Family Medicine and Population Health

More information

THE UROLOGY GROUP

THE UROLOGY GROUP THE UROLOGY GROUP www.urologygroupvirginia.com 1860 Town Center Drive Suite 150/160 Reston, VA 20190 703-480-0220 19415 Deerfield Avenue Suite 112 Leesburg, VA 20176 703-724-1195 224-D Cornwall Street,

More information

Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection

Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection DOI 10.1186/s40064-016-3176-3 RESEARCH Open Access Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection Yuxiao Zheng, Yuan Huang, Gong

More information

The prevalence of malocclusion among 7 15-year-old Lithuanian schoolchildren

The prevalence of malocclusion among 7 15-year-old Lithuanian schoolchildren The prevalence of malocclusion among 7 15-year-old Lithuanian schoolchildren 147 Department of Orthodontics, Kaunas University of Medicine, Lithuania Key words: malocclusion; prevalence. Summary. The epidemiological

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