Additional Information
Book Details
Abstract
PSA screening remains highly controversial due to several important disadvantages. More PSA is produced with prostatic enlargement and in other benign conditions such as urinary tract infections. False positive tests can then lead to unnecessary diagnostic workup with invasive prostate biopsy. Another major problem with screening programs in general is overdiagnosis of cancers that would not have caused harm during the patient's lifetime. For example, many prostate cancers have a relatively indolent behavior so may not require diagnosis or treatment in a patient with limited life expectancy. All forms of prostate cancer treatment have potential urinary and sexual side effects, so reducing overdiagnosis and overtreatment are critical public health issues. Because screening has many proven benefits but also significant harms, there are widely disparate guidelines on prostate cancer screening from major organizations worldwide. This issue of the Urologic Clinics will provide insights into the many different prostate cancer guidelines and related policy issues.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Early Detection of\rProstate Cancer | i | ||
| copyright\r | ii | ||
| Contributors | v | ||
| Contents | vii | ||
| Urologic Clinics Of North America\r | x | ||
| Foreword\r | xi | ||
| Preface\r | xiii | ||
| What Do the Screening Trials Really Tell Us and Where Do We Go From Here? | 223 | ||
| Key points | 223 | ||
| Introduction | 223 | ||
| The large randomized prostate cancer screening trials | 224 | ||
| The PLCO Screening Trial | 224 | ||
| The ERSPC Screening Trial | 225 | ||
| Where do we go from here? | 226 | ||
| References | 227 | ||
| Evolution and Immediate Future of US Screening Guidelines | 229 | ||
| Key points | 229 | ||
| History and evolution of guidelines | 229 | ||
| Prostate cancer screening guidelines | 230 | ||
| What issues will be addressed in the immediate future? | 232 | ||
| Will Screening Be Supported in the Future? | 232 | ||
| At What Age Should Screening Start? | 232 | ||
| When to Stop Screening? | 232 | ||
| How Often to Screen? | 233 | ||
| Should DRE Be Part of Initial Screening? | 233 | ||
| When to Biopsy? | 233 | ||
| Should PSA Velocity Be Used? | 233 | ||
| Summary | 234 | ||
| References | 234 | ||
| International Perspectives on Screening | 237 | ||
| Key points | 237 | ||
| Introduction | 237 | ||
| Prostate cancer and life expectancy | 237 | ||
| Randomized prostate cancer screening trials | 238 | ||
| Guidelines on prostate cancer screening | 240 | ||
| Screening initiatives worldwide | 240 | ||
| Population-Based Screening in Lithuania, the Early Prostate Cancer Detection Program | 240 | ||
| The Stockholm 2–3 Project | 242 | ||
| The Prostate Cancer Risk Management Program in the United Kingdom | 243 | ||
| PSA-Based Screening or Risk-Based Screening, Individual Risk Assessment for Prostate Cancer: an Impact Analysis, the Nether ... | 243 | ||
| PSA Mass Screening in the Federal State of Tyrol, Austria | 243 | ||
| PSA-Based Screening in Asia | 244 | ||
| Summary | 244 | ||
| References | 245 | ||
| The Politics of Prostate Cancer Screening | 249 | ||
| Key points | 249 | ||
| The history and mission of the USPSTF | 250 | ||
| The USPSTF and prostate cancer screening | 251 | ||
| The USPSTF and breast cancer screening | 252 | ||
| Political next steps in the prostate cancer screening debate | 253 | ||
| Summary | 254 | ||
| References | 254 | ||
| Decision Making and Prostate Cancer Screening | 257 | ||
| Key points | 257 | ||
| Why are prostate cancer screening decisions so challenging? | 258 | ||
| What do prostate cancer screening guidelines say about decision making? | 258 | ||
| Implementation of screening guidelines | 259 | ||
| Shared decision making and patient decision aids | 262 | ||
| Summary | 264 | ||
| References | 265 | ||
| Emerging PSA-Based Tests to Improve Screening | 267 | ||
| Key points | 267 | ||
| Introduction | 267 | ||
| PSA-based screening for prostate cancer | 267 | ||
| PSA | 268 | ||
| Additional human kallikreins as tumor markers | 269 | ||
| The use of combinatorial panels of kallikrein biomarkers | 270 | ||
| Summary | 271 | ||
| References | 271 | ||
| The Epidemiology and Clinical Implications of Genetic Variation in Prostate Cancer | 277 | ||
| Key points | 277 | ||
| Introduction | 277 | ||
| Usefulness of rare genomic variation in screening for and treatment of prostate cancer | 278 | ||
| Usefulness of common genomic variation and screening for prostate cancer | 279 | ||
| Usefulness of common genomic variation to improve current serum PSA screening | 283 | ||
| Usefulness of common genomic variation in identifying aggressive disease | 284 | ||
| Usefulness of somatic markers in screening for and diagnosis of prostate cancer | 286 | ||
| Usefulness of differences in tumor gene expression in screening for and treatment of prostate cancer | 286 | ||
| Usefulness of copy-number alterations in screening for and treatment of prostate cancer | 288 | ||
| Usefulness of gene translocations in screening for and treatment of prostate cancer | 288 | ||
| Summary | 289 | ||
| Acknowledgments | 289 | ||
| References | 289 | ||
| Optimization of Prostate Biopsy | 299 | ||
| Key points | 299 | ||
| Optimizing prostate biopsy in clinical practice: core number and location | 299 | ||
| Cancer Detection Rate | 299 | ||
| Likelihood of Clinically Significant/Insignificant Prostate Cancer | 300 | ||
| Negative Predictive Value/Avoidance of Repeat Biopsy | 301 | ||
| Pathologic Concordance Between Biopsy and Radical Prostatectomy | 301 | ||
| Influence of biopsy technique | 301 | ||
| Transrectal | 301 | ||
| End-fire versus side-fire cancer detection rates | 301 | ||
| Computerized templates for prostate biopsy | 302 | ||
| Magnetic Resonance Imaging–Guided Prostate Biopsy | 303 | ||
| Repeat prostate biopsy | 304 | ||
| Indications | 304 | ||
| High-grade intraepithelial neoplasia, atypical small acinar proliferation, and rising prostate-specific antigen | 304 | ||
| Technique | 304 | ||
| Focal saturation, 12-core biopsy, saturation biopsy | 304 | ||
| Transperineal saturation biopsy | 305 | ||
| MRI-targeted repeat prostate biopsy | 305 | ||
| Pain control | 305 | ||
| Technique of Anesthesia | 305 | ||
| Complications | 306 | ||
| Incidence of Prostate Biopsy Complications | 306 | ||
| Bleeding Complications | 306 | ||
| Prevention of prostate biopsy complications | 306 | ||
| Influence of technique | 306 | ||
| Management | 307 | ||
| Infectious Complications | 307 | ||
| Prevention | 307 | ||
| Technique | 307 | ||
| Management | 308 | ||
| Quality of Life | 308 | ||
| Erectile dysfunction | 308 | ||
| Urinary retention | 308 | ||
| Other | 308 | ||
| Summary | 308 | ||
| References | 308 | ||
| Screening and Detection Advances in Magnetic Resonance Image–Guided Prostate Biopsy | 315 | ||
| Key points | 315 | ||
| Introduction | 316 | ||
| Advent of MRI for diagnosis of CaP | 316 | ||
| Current use of MRI for diagnosis of CaP | 316 | ||
| mp-MRI | 317 | ||
| Image fusion | 318 | ||
| Methods of MRI-guided biopsy | 318 | ||
| MRI-US fusion devices | 319 | ||
| Value of targeted biopsy | 322 | ||
| Previous Negative Biopsy | 322 | ||
| Patient example: previous negative biopsy | 324 | ||
| Active surveillance | 324 | ||
| Patient example: active surveillance | 325 | ||
| Summary | 325 | ||
| References | 325 | ||
| Management of an Increasing Prostate-Specific Antigen Level After Negative Prostate Biopsy | 327 | ||
| Key points | 327 | ||
| Introduction | 327 | ||
| Risk of false-negative results with prostate biopsy | 328 | ||
| Predictors for repeat prostate biopsy | 328 | ||
| High-Grade PIN and ASAP | 328 | ||
| DRE, PSA and PSA Derivatives | 328 | ||
| PCA3 | 329 | ||
| TMPRSS2-ERG Fusion | 329 | ||
| Cancer Field Defect Markers | 330 | ||
| Advanced imaging | 330 | ||
| Color Doppler and Power Doppler Imaging | 330 | ||
| Elastography | 330 | ||
| Multiparametric Magnetic Resonance Imaging | 331 | ||
| Repeat biopsy technique | 331 | ||
| TRUS-Guided Biopsy for Repeat Biopsy | 331 | ||
| Role of Saturation Biopsy | 331 | ||
| Transperineal Template Prostate Biopsy for Repeat Biopsy | 332 | ||
| Biopsy of MRI Lesion | 334 | ||
| Summary | 335 | ||
| References | 335 | ||
| When is Prostate Cancer Really Cancer? | 339 | ||
| Key points | 339 | ||
| The science of diagnosing cancer | 339 | ||
| The Hallmarks of Cancer | 339 | ||
| Metastasis Is Not a Reliable Defining Feature of Cancer | 339 | ||
| Invasive Features Distinguish Prostatic Intraepithelial Neoplasia from Prostate Cancer | 340 | ||
| Molecular Features Distinguish Prostatic Intraepithelial Neoplasia from Prostate Cancer | 341 | ||
| Intraductal Carcinoma of the Prostate | 341 | ||
| The Race to the Basement | 342 | ||
| Which Prostate Cancer Cells Invade and Metastasize? | 342 | ||
| The problem of diagnosing Gleason score 6 as cancer | 342 | ||
| Most Prostate Cancers are Not Life-Threatening | 342 | ||
| The Modern Gleason Scoring System | 342 | ||
| The Updated Gleason Scoring System Starts at 6 Out of 10 | 343 | ||
| Overtreatment of Prostate Cancer | 343 | ||
| The problems of not diagnosing Gleason score 6 as cancer | 343 | ||
| Risk Associated with Downgrading Gleason 6 to a Benign Disease | 344 | ||
| A solution that matches the biology with the behavior | 344 | ||
| Summary | 344 | ||
| References | 345 | ||
| Index | 347 |