PSA Testing Importance of Multiple Markers

1
PSA TestingImportance of Multiple Markers

• Ian Thompson MD
• Department of Urology
• University of Texas HSC
• San Antonio, TX

2
Thompson IM et al. N Engl J Med 20043502239-46
3
(No Transcript)
4
Population Screening with PSATrue Outcomes
4.0
Screen 10,000 Men PSA 4 760 Cancer
190 High grade 36 PSA lt4
9240 Cancer 1386 High grade 208
PSA 4 7.6 Positive biopsy
25 High grade 19
lt4.0
Normal PSA 92.4 Positive biopsy
15 High grade 15
PSA
SEER, PCAW, Prostate Cancer Prevention Trial Data
5
Pause for a moment

• You read in a throwaway magazine about the
  benefits of a bASA daily.
• You worry about GI upset.
• You ask your own PCP, should I take a bASA?
• How do they assess your risk?

6
10-year risk of coronary artery disease
7
So why do we use just PSA?

• DRE
• Age
• Race/ethnicity
• Family history
• Prior negative biopsy
• PSA velocity

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Lets just take some examplesPoint in play
Dichotomy of DRE as a solitary measure of risk

• 55 yo WM, -FHx, DRE, no prior bx, PSA 0.3
  recommendation?
• Biopsy, right?
• 68 yo AAM, FHx, DRE-, no prior bx, PSA 2.4
  recommendation?
• No biopsy, right?

15
This example (DRE dichotomy)

• 55 yo WM, -FHx, DRE, no prior bx, PSA 0.3
• 68 yo AAM, FHx, DRE-, no prior bx, PSA 2.4
• What are these mens risk of disease?
• 1st man Cancer13 High grade cancer1
• 2nd man Cancer31. High grade 11.
• Doesnt make any sense, correct?

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
The Next Step

• Adding Body Mass Index
• Adding Population Norms
• Adding pro-PSA

20
(No Transcript)