Prostate Cancer

An array of new tools, perspectives, and guidelines to help navigate the gray areas have been reported in recent days.

Three factors may help physicians identify older men who are unlikely to benefit from aggressive therapy, and other prostate cancer news.

A video series from James Mohler of Rosweel Park Cancer Institute on PSA testing in the wake of changing guidelines from the US Preventive Task Force.

James Mohler, MD, Roswell Park Cancer Institue, discusses risk factors for prostate cancer.

James Mohler, MD, Roswell Park Cancer Institute, defines who is at risk for prostate cancer, how to decide who should be screened, and how to talk to patients about the test and their results.

James Mohler, MD, of Roswell Park Cancer Institute, points out the flaws in the TaskForce analysis.

Roswell Park Cancer Institue's James Mohler, MD, on the risks of PSA screening

James Mohler, MD, Roswell Park Cancer Institute, responds to recommendations from the US Preventive Services Taskforce to limit PSA testing by pointing out the benefits.

RPCI's Dr Mohler offers advice on following new guidelines for prostate cancer screening

Marc B. Garnic, MD, addresses these questions in this short video. Dr Garnic, who spoke on this topic at the 2011 American College of Physicians meeting in San Diego

Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.

Benign prostatic hyperplasia (BPH)-histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate-affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.

To screen or not to screen? The answer is not straightforward when it comes to prostate cancer. Recently updated guidelines from the US Preventive Services Task Force (USPSTF) recommend against prostate- specific antigen (PSA) screening in men who are 75 years and older and state that there is insufficient evidence to confirm whether screening is beneficial-or harmful -to men younger than 75 years.1,2 The recommendations are summarized in the Table.

BOSTON -- Older male clinicians are more likely than others to order inappropriate prostate specific antigen (PSA) tests, researchers here said.

ANAHEIM, Calif. -- Testosterone levels appear to have a major influence on PSA values and may warrant watching for patients at high risk of prostate cancer, a large screening program suggests.

ANAHEIM, Calif. -- A single PSA measurement in middle age can predict a prostate cancer risk up to 25 years later, a Swedish researcher reported here.

KISSIMMEE, Fla. -- After definitive prostate cancer therapy, there is little value in imaging studies when patients with biochemical failure are asymptomatic and have PSA levels less than 5 ng/mL, researchers here reported.

KISSISSIMEE, FLA. -- Escalated-dose conformal radiotherapy for localized prostate cancer was associated with a 34% reduction in the relative risk of biochemical failure in a randomized trial of 843 men also with treated with androgen deprivation therapy.

My patient is a 78-year-old man who complains of severe exhaustion, lack of energy,and hot flashes.

A 73-year-old man is admittedto the hospital with pulmonary tuberculosis.A 3-drug fixed combination-isoniazid, rifampicin, and pyrazinamide-and ethambutol are given.Within an hour, a global urticarialrash erupts (A and B).

A 73-year-old man is admittedto the hospital with pulmonary tuberculosis.A 3-drug fixed combination-isoniazid, rifampicin, and pyrazinamide-and ethambutol are given.Within an hour, a global urticarialrash erupts (A and B).

Highlights:➤What to tell your patients about thebenefits-and risks-of mammography.➤A realistic look at cancer screening: Arewe overstating the benefits?➤Which screening strategies you canrecommend with confidence.➤How best to bring the patient into thedecision-making process.

PSA velocity, not a man's absolute PSA level, is a better predictor of prostate cancer risk, according to a study from the Johns Hopkins School of Medicine. The findings suggest that screening should begin at age 40, not 50.

DALLAS -- As low-dose Propecia (finasteride) stimulates hair growth for male pattern baldness, it appears to suppress prostate specific antigen (PSA) levels, a researcher here reported.

During a routine checkup, a middle-aged woman asks you whether she should stop wearing moisturizers and makeup that contain sunscreen. She has read that increased sunlight exposure enhances vitamin D production, which may prevent certain types of cancer. What would you tell her?

ABSTRACT: Prostate-specific antigen (PSA) recurrence is the most common form of advanced prostate cancer. Salvage therapies may be effective even among some high-risk men, although long-term cancer control data are limited. The natural history of PSA recurrence is long but variable. The postrecurrence PSA doubling time can identify men at high risk for progression and death. Early hormonal therapy, possibly via combined androgen blockade, may reduce the risk of progression and improve cancer-specific survival among men with high-risk recurrence. Men with low-risk recurrences likely receive minimal benefit from aggressive early hormonal therapy and may actually be harmed.

SAN FRANCISCO -- Older men with limited life expectancies are getting screened much too often for prostate cancer, given the potential harm that may follow a positive test versus the likelihood of benefit, researchers here reported.

PHILADELPHIA -- External-beam radiation or brachytherapy for prostate cancer sometimes triggers a spike in prostate specific antigen levels, but researchers here said this "bounce" is not clinically significant.

BALTIMORE -- It's the rate of change of prostate specific antigen -- not the absolute PSA level -- that is the key to telling who has a life-threatening malignancy and who doesn't, according to researchers here.

NASHVILLE, Tenn. -- Weight, height, and race independently influence prostate-specific antigen (PSA) levels, and each may distort the risk of prostate cancer, researchers here reported.