Prostate Cancer Update Robert Flynn Screening No national

Prostate Cancer Update Robert Flynn

Screening � No national screening policy � Pros �Early detection – reduced Ca. P mortality by 20% �NNI 781 NND 27 at 13 years � Cons �Over detection/treatment of insignificant disease �Morbidity of screening � Advocate if family history – baseline PSA at 40 years.

Diagnosis � DRE and PSA � Pre-biopsy mp. MRI �Assessment of prostate volume and calculation of PSA density �Identification of suspicious lesions – Pirads Scoring System �Fusion biopsy of abnormal area(s) �Transperineal Template biopsy if PSA density high ( > 0. 15) and no abnormal focal areas.

mp. MRI Prostate

Precision Trial

Active surveillance � Preferred option for low risk disease �c. T 1 c, PSA < 10, Gleason Score < 6, < 2 cores, < 50% core length � 70% remain on AS at 10 years � Changing field �mp. MRI at enrolment �mp. MRI may replace subsequent biopsy � Caution in younger men (<50 year old)

PSMA PET � Novel imaging technology with increased detection rates �PSA 0 -0. 19 : 33% +ve �PSA 0. 2 -0. 49 : 45% +ve �PSA 0. 5 -0. 99 ; 59% +ve �PSA 1 -1. 99: 75% +ve �PSA > 2 : 95% +ve � Role �Pre-treatment, especially in high risk patients �Biochemical recurrence post radical treatment

PSMA PET

Prostate cancer service � Rapid diagnostics � Standard, fusion and Template prostate biopsies � Weekly MDT meeting � Urology cancer nurse support � Latest Radiotherapy services � Robotic Radical Prostatectomy