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Prostate cancer (screening)
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2. G. Pourmand MD. Tehran University of Medical Sciences May- June 2008 Point counterpoint: Prostate cancer in the elderly man: Should we screen men after age 65 years?
3. Yes No Is prostate cancer a health care problem?
4. Is cancer prevalence important? Health planning Benefits and Harms Most are small, confined
18. BPH Prostatitis Prostatic Infarction Is PSA Ideal Tumor Marker?
19. PSA thershold = 4 ng/mL: 65% F. Positive rate 20% F. Negative rate PSA: 3 ng/mL Sensitivity Positive Predictive Value
20. PSA Density PSA Velocity Age Specific Reference May Increase Sensitivity and specificity
21. Age Specific PSA, Reference Range Age, yr Reference Range, ng/ml 40-49 …………………….. 0.0-2.5 50-59 …………………….. 0.0-3.5 60-69 …………………….. 0.0-4.5 70-79 …………………….. 0.0-6.5
22. Use of PSA and PSA density to detect prostate cancer in men with normal DRE PSA density (Threshold) Sensitivity % Specificity % Positive Predictive Value % 0.10 …………… 95 24 29 0.15 …………… 79 50 34 0.30 ……………. 45 85 50 0.50 ……………. 29 95 65
26. Digital Rectal Examination • Detect missed Pca by PSA Screening • Able to detect asymptomatic patient • Abnormal DRE (3.2%-10%) • Pca (0.2%-1.7%) in original group
27. ACS DRE + Occult Blood >40 yrs The (+ve) Predictive Value 17.8% Sensitivity of DRE: 53.2% Specificity of DRE: 83.6%
28. Trans Rectal UltraSonography Expensive Not available for family physicians Suffers from lack of specificity
29. Biopsy 1- Elevated PSA + Benign DRE TRUS Visible abnormal lesions 2- Abnormal DRE + TRUS Regardless of PSA
30. Charecteristics of Screening Tests Test Sensitivity % Specificity % Positive Predictive Value % DRE 45-58 96-97 24-58 TRUS 71-91 89-94 15-43 PSA > 4 ng/ml 67-89 59-97 33-47
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32. 1 Andorra 83.53 2 Macau 82.35 … . 47 United States 78.14 … 130 Iran 70.86 … 222 Angola 37.92 223 Swaziland 31.99 World’s Life expectancy report