08-07-2010, 01:53 PM
#2141737
mmullick - 07/05/10 04:56
Kaplan notes has no mention of prostate cancer screening per se and my concept of it was that there's no screening guidelines for Ca. Prostate so i'll just quote what the American Cancer Society says, which is:
1. No proven benefit of screening...they are unclear at best
2. Doctors should discuss the possibility, pros and cons of DRE and PSA testing in patients
aged 50 or over if they are expected to have a life expectancy of over 10 year
3. If the patient is in a high risk group then discuss DRE and PSA option at age 40 (1st degree
relative diagnoses with ca. prostate before age of 65 or a strong family history of Ca.
Prostate is considered high risk)
4. African-Americans should have the "prostate talk" at age 45
At the end of the day, there really isn't any clear standard because everyone disagrees so the best answer would involve discussing it with the patient.
Now, if you do see and enlarged prostate on DRE and get a high PSA, that's also kinda non-specific because elevated PSA can be because of BPH, Ca. Prostate, Prostatitis, ets.
But if the Pt. agrees with annual screening, then i'd follow the PSA levels you mention in the original post.
PSA 4-10: TRUS + Biopsy; If Biopsy negative then % Free PSA
PSA >10: TRUS + Biopsy ; If Biopsy negative then Repeat Biopsy
If Ca Prostate diagnosed after 70 yrs: No need treatment as ca. prostate is not a terrible aggressive cancer, the patient is more likely to die from other causes.
mmullick - 07/05/10 04:56
Kaplan notes has no mention of prostate cancer screening per se and my concept of it was that there's no screening guidelines for Ca. Prostate so i'll just quote what the American Cancer Society says, which is:
1. No proven benefit of screening...they are unclear at best
2. Doctors should discuss the possibility, pros and cons of DRE and PSA testing in patients
aged 50 or over if they are expected to have a life expectancy of over 10 year
3. If the patient is in a high risk group then discuss DRE and PSA option at age 40 (1st degree
relative diagnoses with ca. prostate before age of 65 or a strong family history of Ca.
Prostate is considered high risk)
4. African-Americans should have the "prostate talk" at age 45
At the end of the day, there really isn't any clear standard because everyone disagrees so the best answer would involve discussing it with the patient.
Now, if you do see and enlarged prostate on DRE and get a high PSA, that's also kinda non-specific because elevated PSA can be because of BPH, Ca. Prostate, Prostatitis, ets.
But if the Pt. agrees with annual screening, then i'd follow the PSA levels you mention in the original post.
PSA 4-10: TRUS + Biopsy; If Biopsy negative then % Free PSA
PSA >10: TRUS + Biopsy ; If Biopsy negative then Repeat Biopsy
If Ca Prostate diagnosed after 70 yrs: No need treatment as ca. prostate is not a terrible aggressive cancer, the patient is more likely to die from other causes.