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ScreeningaInformed consent about risks vs benefits is extremely important before starting screening Is difficult to inform patients because there are different interpretations of benefits Urologists: late cancer is untreatable Generalist: cancer is often asymptomatic and often not cause of death Understanding all of the data is difficult even for professionalsNZYmBZYmB  C Informed consent should includeXProstate Ca is an important problem Benefits of screening have yet to be proven DRE and PSA testing both have high false positive and false negative results If positive, invasive evaluation will be required Aggressive therapy which may cause significant side effects required to benefit from discovery of a tumor Early detection may safe livesYZY When to start screening?Discuss screening at age 50 If pt has a comorbidity limiting life expectancy to less than 10 years, should not recommend screening African American males and those with a family hx of CA should discuss screening at age 40-45,( -Screening strategyDRE for all men over 50 annually Screen PSA every 4 years for men who have PSA less than 1.0, annually if higher Based on slow progression Studies show low risk of progression Send for bx if abnormal DRE Send for bx if PSA >4.0 May wait and repeat PSA in several weeks because of high variability May use PSA velocity or density, free or complexed PSA and race to modify decision If > 7.0, should send for bx without further testing If normal bx, may resume normal screeningvqZAZ4ZZ*ZqA4  *b{ <#When to stop screening|Lack of consensus Possible strategies Older than 75 yo (less than 10 yrs of life expectancy) If 65 yo or older and PSA < 0.5&&W&W,4-Recommendations by expertsUSPSTF  not sufficient evidence to recommend for against DRE/PSA Canadian Task Force  recommends against screening with PSA and insufficient evidence for/against DRE European Union  against screening until results of randomized trials have been analyzed ACS  PSA/DRE with informed consent for males older than 50 with life expectancy of 10 years, 45 years for AAM or family hx. AUS supports this. ACP  similar to ACS but states that decisions should be individualized with patient Zzl Bibliography Screening for Prostate Cancer: Current Status and Future Prospects. American Journal of Medicine (2007) 120, 743-745.  Screening for prostate cancer: A Cochrane systematic review Cancer Causes Control (2007) 18:279-285. Up To Date.  Prostate Screening.    0` fy`ff3` Mj*333FV*` ffNNt^X` ffNL|>rL` +T3f3f` MMMff3f` Lx[he2` {$$>?" dd@,?nAd@    @ `  n?" dd@   @@``PR    @ ` ` p>> P(  P P 6݄ " `P < T Click to edit Master title style! !$ P 0` " ` < RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S P 6P #" `^ ` < J* 0C P 60 #" `^  < L*"0C P 6 #" `^ ` < L*"0Cz P NA޽h ?texture_mid#" @@ +T3f3f80___PPT10. ` Textured 0 [S T(  T T < #" `  < T Click to edit Master title style! ! 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