Prostate Cancer Prevention PSA Screening Treatment Technologies by SillyWoodcock


 Brief History of PSA and
Prostate Cancer Screening

           David Cho, MD
    Roswell Park Conference for
Therapist and Dosimetrist Sept 2009
   Early PSA History
   Spike in Prostate Caner Incidence/
    Decline in Prostate Cancer Mortality
   Does Prostate Cancer Screening with
    PSA decrease Prostate Cancer Deaths?
   PLCO & ERSCP Studies
Lupron Injection (5 mg/mL for daily subcutaneous
injection) was first approved by the FDA for
treatment of advanced prostate cancer on April 9,

Zoladex (goserelin) approved by the U.S. Food and
Drug Administration in 1989
1653 PSA Screening          vs      300 Symptoms/Abnl Rectal
107 (6.5%) PSA 4-10 -> 19 +cancer
30 (1.8%) PSA >10 -> 18 +cancer
              Uses for PSA
   Sign of prostatitis, BPH
   Prostate cancer screening
   Aggressiveness of prostate cancer
   Assess response to therapy
   Assess response to salvage therapy
   Monitor progression of metastatic dz
   ID semen in forensic serology
 Outside of Randomized Trails, were there Population or
   Epidemiological Series That look at Prostate Cancer
Survival before and after PSA introduction that could help
    answer if PSA testing decreases Prostate Cancer

      Does PSA Screening Result in
           Reduced Mortality?
   Tyrol, Austria         Yes
   Olmsted County, MN     Yes
   US SEER                Yes
   France                 Yes
   Saskatchewan, CA       Yes
   British Columbia, CA   No
   Western Australia      No
   Quebec, CA             No
#of Deaths 10 yrs

92 Screened Grp

82 Controll Grp
              Why no benefit?
   1. PSA level 4ng/ml vs 3ng/ml

   2. Too many PSAs in control group

   3. Too many PSAs and rectal exam
    before study

   4.   Improvements in treatments

   5    Not enough followup
Cummulative Prostate   8.2%   4.8%
Cancer Incidence
Absolute risk difference 0.71 death per 1000 men

1410 men would need to be screened (1068 actual
PSAs) & 48 additional people would have to be treated

To prevent one death from prostate cancer.
            ERSPC Findings
   20% relative risk reduction of prostate
    cancer death at 9y followup
   Absolute reduction of 7 prostate cancer
    deaths per 10,000 men screened.
   1410 men would need to be screened
    (1068 men actual PSA tested) and 48
    men with prostate cancer would need
    to be treated to prevent one death
    from prostate cancer.
       Why such a small benefit?
    Possible larger difference in % of men
    who had PSA in the screened vs control
    groups for the ERSPC study vs PLCO
   Larger study with more power in ERSPC

   PSA screening for prostate cancer might
    not prevent prostate cancer mortality
   Not enough follow up?
   PSA has become the most commonly
    used tumor marker for any cancer and is
    indispensable for prostate cancer
   Restrospective data on PSA screening to
    reduce prostate cancer mortality are
    mixed on the benefits for PSA
   Recent PLCO and ERSCP studies show no
    benefit for PSA screening to lower
    prostate cancer mortality, more followup
    is needed

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