CC May 2015 PSA counseling and testing

echoecho's version from 2015-05-06 18:06


Question Answer
What marker for prostate CA was first introduced in the late 1980's?PSA
In the US vs UK (where < 10% of men are screened), compare death rates?both death rates declined (to a lesser degree in the UK)
Why is there a controversy about PSA testing?concerns about overdiagnosis and the associated morbidity and mortality due to subseuqent evaluation and treatment
What is the recommendations for prostate CA screening from the USPSTF?recommends AGAINST PSA-based screening for prostate CA (D recommendation)
What is the recommendations for prostate CA screening from the American Cancer Society?1. does NOT recommend ROUTINE screening in ANY age group 2. asymptomatic men with a least a 10 year life expectancy shouldhave the opportunity to make an informed dicision (starting at age 40 y.o. for high-risk men and age 50 y.o. for average risk men)
What is the recommendations for prostate CA screening from the Aua (American Urological Association)?1. recommends AGAINST screening in men < 40 y.o. 2. does NOT recommend ROUTINE screening for average-risk men 40-54 y.o. or men > 70 y.o. or men with a life expectancy of < 10-15 years 3. for men 55-69 y.o. of age, shared decision making needed with testing based on man's values and preferences
What are 2 things that a provider has to do so that there is shared decision making with the patient?1. educate men about prostate CA risk 2. risks and benefits of PSA screening
Question Answer
The risk for prostate CA increases with ____?age
What ethnic groups is prostate CA more common in?1. AA 2. Hispanics 3. whites
What ethnic group is prostate CA less common in?asian americans
What ethnic group is age of onset earlier for?AA
Risk is double for men with a ____-degree affected relative?first
Risk increases more with additional affected ____-degree relatives? ____-fold increase with 2; ____-fold increase with 3?first, 5, 10
Risk is increased if the family member was diagnosed at what age (older or earlier)?earlier age
What genetic factors play an increased role in prostate CA risk?BRCA 1 and 2 mutations
What is the current lifetime risk for development of clinically evident prostate CA?This 1 in _____ men?16.7%, 6
What is the current lifetime risk of dying with clinically evident prostate CA? 2.4%
What % of men 70-80 y.o. have histologic evidence of prostate CA? Those in > 80 y.o. group?50%; 2/3rds
Given the above statistics regarding histologic evidence of prostate CA in certain age groups, conclusion can be drawn that the majority of prostate cancers ___ (do vs. do not ) become clinically evident?do not
Question Answer
Randomized studies show that PSA screening results in lower ____ and ____ of tumor at the time of dx?stage; grade
Is the effect of screening on prostate cancer - specific mortality clear?no it is somewhat less clear
List the two trials that were done that studied mortality in it's relationship with screening and their respective results?1. ERSPC (European Randomised Study of Screening for Prostate Cancer) found that screening significantly lowered mortality 2. PCLO (Prostate, Colorectal, Lung, Ovarian Cancer) screening trials found NO difference in mortality. However, there were a number of criticisms of the PCLO trial that bring into question the validity of the findings).
In the US, the advent of screening was associated with a ____ (decrease vs. increase) in the incidence of metastatic disease at the time of dx?decrease
The ERSPC study showed that the cumulative risk of development of metastatic disease at 9-11 years of f/u was ____ to ___% lower in the screening group?31-33%
Further benefits may involve decrease in morbidity, give 2 examples?bladder outlet obstruction, bone pain
Question Answer
*** The ______ (sensitivity vs. specificity) of PSA testing is low (significant number of false-______ results) with the _______ (sensitivity vs. specificity) varying with the chosen threshold?specificity; positive; specificity
*** Lower cutoffs (2.5 - 4.0 ng/mL) yield ____% false positive results?80%
*** Using a cutoff of 4.0 ng/mL, the sensitivity is _____% for any prostate cancer and ____% for high-grade cancers (Gleason > 8); using a cut-off of ___ ng/mL increases sensitivity? 21%, 51%; 3
Lower cutoffs improve _______ (sensitivity vs. specificity) but further decrease _______ (sensitivity vs. specificity)?sensitivity; specificity
The positive predictive value of a PSA > 4.0 ng/mL is ____%?30%
The specificity of PSA testing with a cutoff of 4.0 ng/mL is _____%?91%
For every 1000 men tested, how many men will have an elevated test and the majority will undergo a biopsy?100-120
Of these 100-120 men, what % will have mild to severe complications (pain, fever, bleeding, infection, difficulty urinating)?1/3 of the 100-120 men
Of these 100-120 men, what % will be hospitalized in the 30 days following the biopsy (___% for infection)?4%; 75%
Of men diagnosed with prostate CA, what % will undergo treatment?90%
List the 3 outcomes of treatment?1. recurrence of CA w/ progression regardless of treatment 2. no evidence of disease recurrence but no benefit of treatment because their cancer was not going to progress 3. no evidence of recurrence because cancer is cured
Why is the 2nd outcome above problematic?these men will undergo treatment and may suffer complications related to treatment (incontinence, ED) for a cancer that was not going to be clinically evident
The psychological impact of the dx of prostate cancer must also be considered, true or false?true
Based on data from ERSPC, for men 55-69 y.o. who choose NOT to be screened, ____ out of 1000 will develop clinically evident prostate CA in the next 10-14 years and ____ out of 1000 will die of the disease within 10-14 years?60; 5
For men in the same age group who choose TO BE screened, ____ of 1000 will develop clinically evident disease and ___ out of 1000 will die of their disease?96; 4
For this time interval, ____ life would be saved for every 1000 men screened?one
It is estimated that if this is projected over a lifetime (not just 10-14 years), ____ lives could be saved per 1000 men screened?6
List the 4 facts that should be asked when deciding if a patient should be screened for prostate cancer?1. age 2. health status 3. life expectancy 4. personal preference
What is the AUA-recommended screening interval for PSA screening?2 or more years
The American Cancer Society recommends that men who elect screeing, a 2 year interval for men with PSA levels < _______ ng/mL and annual screening for those with levels > ____ ng/mL?2.5; 2.5