USA-Dr. Deepak Kapoor Discusses PSA Screening Guidelines

Dr. Deepak Kapoor Discusses PSA Screening Guidelines

 

Deepak A. Kapoor, MD

Published Online: Wednesday, May 22, 2013

 

Deepak A. Kapoor, MD, president of the Large Urology Group Practice Association, chairman and CEO of Integrated Medical Professionals, PLLC, believes that regardless of what the guidelines says, urologists are united in their defense of a patient's right to access PSA testing, if it is clinically appropriate.

Over the past two decades, since the advent of broad-base cancer screening, the prostate cancer specific death rate has decreased by nearly 40%, Kapoor says. Additionally, the 10-year survival rate has increased from 53% to over 97%. Simultaneously, adds Kapoor, the incidence of prostate cancer has remained unchanged, indicating that screening did not just detect more cancer but that it also detected cancer earlier, which saved lives.

The most recent set of PSA screening guidelines provide a more nuanced approach than was recommended by the USPSTF over a year ago, which recommended doing away with PSA screening for all men. Kapoor believes the USPSTF recommendation was ill advised and could result in setting back the progress made in prostate cancer over the last 20 years.

The current guidelines, Kapoor says, recognize that it is ultimately the patient's decision whether or not to have PSA screening. Additionally, he notes, there is a role for screening in older men and for young men at high-risk for developing prostate cancer, specifically African American men and those with a family history.

Kapoor believes it is critically important for men understand that the decision to be tested for prostate cancer is personal and should be made in conjunction with consultation from a physician.

For a link to the website which contains a video of  Deepak A. Kapoor, MD views click link below:

 

Screening Remains Critical to Optimal Management of PC

A couple of posts relating to the ever changing views on PSA testing/screening within the USA that maybe of interest further afield too.
This has been taken from OncLive and I hope they don't mind me copying their articles on here,I'll add a link to their website within the main section found within April 2009 under General,Urology and Charity Websites
            
http://www.onclive.com/

Screening Remains Critical to Optimal Management of Prostate Cancer

Jason M. Broderick

Published Online: Tuesday, May 28, 2013

 

The mortality rate from prostate cancer has declined significantly in the past few decades; however, there is much debate over how much PSA screening contributed to that decline. At the 2013 IPCC®, Leonard G. Gomella, MD, discussed his view that PSA screening, while not solely responsible for the reduction, is a critical component of prostate cancer management and should continue to be used with the appropriate patients.

“We have seen that the mortality [from prostate cancer] since the 1990s has continued to go down. And, in fact, if you look at the interval from about 1991 and you move it forward to about 2010- 2011, you’ll see almost a 50% decline in mortality [Figure],” said Gomella, professor and chairman of the Department of Urology, and director of Clinical Affairs at the Jefferson Kimmel Cancer Center, Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. “We are starting to see metastatic cancer go away, and PSA has led to stage migration—earlier and more treatable cancers, and we’ve seen the survival rate go up dramatically, so PSA screening is doing something good.”

Gomella stressed that screening alone did not produce the mortality decline. Rather, the synergistic effect from combining screening with treatment has improved outcomes. “[Screening is] one of the pieces of the puzzle that is improving the mortality from prostate cancer. It’s not all about screening—there are treatment effects [as well].”

What Does the Literature Show?

Gomella’s support for screening is rooted in clinical studies that have examined PSA testing. While initial trial results have varied, Gomella said the longer you follow-up and the closer you examine even the negative trials, the support is there for PSA screening. Of the three largest trials, the European Randomized Study of Screening for Prostate Cancer (ERSPC; N Engl J Med. 2009;360:1320-1328) and the Göteborg trial (Lancet Oncol. 2010;11[8]:725-732) showed that PSA screening reduced prostate cancer mortality rates.

 

The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (N Engl J Med. 2009;360:1310- 1319) did not demonstrate a reduction in mortality; however, “In post-hoc analysis [of the PLCO data], it showed that if a man had more than one PSA test done, that he had a 25% reduction in his risk of prostate cancer death.” There was also contamination in the PLCO, as many men in the control group had PSA screening done outside of the trial. Additionally, Gomella said that a reanalysis of the PLCO data showed that if you “looked at men who had comorbidities and took them out, the study was positive.”

Gomella also noted that with screening studies, long-term follow-up is critical to demonstrating the true benefit of PSA testing. The data show that “as time goes on, the benefit of screening becomes greater and greater,” he said. For example, with the 11-year follow-up of the ERSPC (N Engl J Med. 2012;366[11]:981-990), the number of men who needed to be screened to prevent one prostate cancer death dropped from 1440 to 1055. Additionally, the number of men who needed to be treated to prevent one death dropped from 48 to 37.

Gomella said the bottom line with the clinical trial evidence is that screening is effective; however, the data do not support general population screening. To avoid overtreatment, screening should be targeted to specific individuals, according to Gomella. “[Screening]…makes sense in certain populations—those at high risk for the disease, those at high risk for death or morbidity from the disease, and those in good health [few comorbidities and a life expectancy of at least 10-15 years].”

Is PSA Screening in Jeopardy?

Gomella’s staunch defense of screening came amid concern from him and many of his colleagues that the use of PSA testing may be in jeopardy.
 

Historically, the authoritative US organizations—the US Preventive Services Task Force (USPSTF), the National Comprehensive Cancer Network, the American Cancer Society (ACS), and the American Urological Association—recommended some form of screening. However, in 2012, the USPSTF gave PSA screening a “D” rating, recommending against screening any asymptomatic male for prostate cancer.
 

“The thing that [upset] most of us was the fact that they said, ‘Don’t screen someone until they have symptoms.’ Well that completely breaks our principle of screening men for prostate cancer who are symptomatic, when it’s most curable,” said Gomella.

The recommendation is particularly disconcerting to Gomella and his colleagues because of its implications under the Affordable Care Act. Medicare is only required to cover “A”- and “B”-rated services. Unless an exception is made, or individual states decide to cover screening, the USPSTF rating would mean Medicare would not be required to cover PSA testing, which would lead to a drastic reduction in screening rates overall.

Gomella is concerned that this could lead to a return to when almost every man diagnosed with prostate cancer had advanced/metastatic disease. “To abandon PSA screening completely is going to take a lot of these men who are benefiting from screening and basically throw them out the window.”

Gomella noted that Kathleen Sebelius, secretary of the Department of Health and Human Services, is on record as stating that PSA screening would still be covered; however, he remains concerned that the “letter of the law” could still be implemented.
 

 

USA-Confused by Guidance on Screening for Risk of Prostate Cancer?

Professionals and Patients Increasingly Confused by Guidance on Screening for Risk of Prostate Cancer

Washington, D.C., May 23, 2013: Representing the interests of the 240,000 American men who are at risk each year for a diagnosis of prostate cancer, and the over 2 million men living today who have been diagnosed with this deadly form of cancer, the membership of the Prostate Cancer Roundtable is increasingly concerned by the utterly confusing guidance being offered – to both the professional healthcare community and to individual consumers — about whether men should or should not be tested (“screened”) for risk of prostate cancer.

At the annual meeting of the American Urological Association (AUA) in San Diego just a few days ago, the AUA issued new guidance about the use of the PSA test to screen men for risk of prostate cancer.1 The newly issued guidance differs radically from prior guidance offered by the AUA itself,2 from guidance offered by the U.S. Preventive Services Task Force in May 2012,3 and from guidance recently issued by the American College of Physicians.4 Each of these three sets of guidance claims to be “evidence based”.

The new guidance also differs from that offered by the National Comprehensive Cancer Network.5

“The members of the Prostate Cancer Roundtable fully appreciate that there is great controversy about the use of PSA testing to screen the average, otherwise healthy, Caucasian male for his risk of clinically significant prostate cancer,” said Ana Fadich, VP of Men’s Health Network. “However, the frequent issuance of new guidance documents by a variety of organizations that present differing recommendations based on what is basically the same set of low quality scientific evidence and related opinion leaves men and their doctors confused, upset, and uncertain about what represents good medical practice today.”

The membership of the Prostate Cancer Roundtable also notes that none of the recently issued guidance documents explicitly address the appropriateness of screening of those men at greatest potential risk for clinically significant prostate cancer (largely because there are no good data that address this critical issue). In other words, there is now no clear message at all being given to healthcare professionals about the need for testing in those men who experts in the management of prostate cancer believe to be at significantly higher risk for clinically significant disease than the average, healthy man of Caucasian ethnicity: men with a family history of clinically significant prostate cancer and men of African-American and Afro-Caribbean ethnicity.

“Multiple studies have shown that black males are at greater risk for prostate cancer-specific mortality than white males of comparable age and health,” stated Thomas Farrington of the Prostate Health Education Network. “The lack of explicit guidance about the need for risk testing in this group is potentially a disaster. We have a prostate cancer epidemic among black Americans. This community in particular needs clarity about the role of the PSA test in screening for prostate cancer.”

“Many would argue that there is strong evidence for the value of a baseline PSA test among men in their 40s,” said Merel Nissenberg of the National Alliance of State Prostate Cancer Coalitions. “Such baseline testing is a way to define individual risk and to help men to understand this. However, even the new guidance from the AUA does not offer any definitive guidance on this issue.”

The Prostate Cancer Roundtable is fundamentally concerned that the contradictory guidance coming from different sectors of the medical community reflects two factors: (1) the lack of really good data that offers incontrovertible evidence about screening for prostate cancer – especially among groups of men who may be at particularly high risk levels, and (2) the failure of the differing sectors of the medical community to come together and develop guidance that is issued in the interests of patients and families as opposed to the interests of the professional healthcare community.

We believe that it is time for real leadership from organizations such as the National Institutes of Health and the Institute of Medicine to look at what is needed to develop definitive evidence about the value of screening for risk of prostate cancer – particularly among those groups of men who are known to be at elevated risk levels because of ethnicity and family history. Until such definitive evidence is available, we further believe that every man should be encouraged to have a serious discussion with his primary care physician about whether some forms of testing for risk of prostate cancer may be appropriate for him as an individual (as opposed to the risk of the average, healthy, Caucasian male of 40 to 70 years of age). It is unacceptable that the data on the risks and benefits of prostate cancer screening available today is still not good enough to offer sound advice to any individual patient about risk related to the most common form of cancer now identified in American males (other than basal and squamous cell skin cancers)!

We would conclude by noting that the members of the Prostate Cancer Roundtable are also fully cognizant of the fact that a diagnosis of low-risk prostate cancer does not and should not necessarily imply any immediate need for treatment. The potential problems associated with over-treatment of low-risk prostate cancer need to be addressed as carefully as the problems associated with failure to diagnose clinically significant prostate cancer early so that it can be effectively treated with curative intent.

About Prostate Cancer
Prostate cancer is the most prevalent form of cancer among American males. Nearly 240,000 men were projected to be diagnosed with prostate cancer in 2013, and approximately 30,000 are projected to die from this disease each year. Any man may be at risk for prostate cancer, but increased risk factors are known to include race, family history, elevated prostate specific antigen (PSA) levels, positive findings on a digital rectal examination, and selected pathological findings on prior biopsies.

About the Prostate Cancer Roundtable
The Prostate Cancer Roundtable, representing America’s prostate cancer community, is a group of independent, patient-centric, not-for-profit organizations that cooperate to foster the development of policies supporting high quality prostate cancer research, the prevention and early detection of clinically significant prostate cancer, the appropriate care and effective treatment of men with prostate cancer, and the appropriate education of all men at risk for this disease.
The following members of the Prostate Cancer Roundtable support this statement:

This was also posted on The "New" Prostate Cancer InfoLink website.

USA-PSA Test Remains a Valued Tool to Detect Prostate Cancer Early

Urologists call for careful consultation between patients and physicians 
 

CHICAGO, May 9, 2013 /PRNewswire/ --

The American Association of Clinical Urologists (AACU), an organization representing specialists who manage prostate cancer and urologic health, issued the following policy statement today concerning early detection of prostate cancer.

"The American Association of Clinical Urologists (AACU) is concerned that recently published guidelines on screening for prostate cancer could unintentionally leave physicians and the general public with the impression that early detection of prostate cancer is no longer needed. The AACU wishes to express its position on the importance of early detection of prostate cancer and the role of PSA screening.

"Prostate cancer is the second leading cause of cancer death in American men. Thus, early detection of prostate cancer is vitally important. Although PSA testing has some limitations as a screening method, it remains a useful tool to help identify prostate cancer in its early stages. Since the introduction of PSA testing and heightened prostate cancer awareness over the past 20 years, there have been significantly fewer advanced prostate cancers at diagnosis and a reduction in deaths attributed to prostate cancer.

"The revised prostate cancer screening guidelines released by the American Urological Association on May 3, 2013, emphasize the importance of continued PSA testing for men between the ages of 55 and 69 and all men at increased risk including African-Americans and those with a family history. For asymptomatic men below age 55 or above age 69 with average risk factors, individualized decisions about the benefits and potential harms of PSA testing need to be discussed between the patient and his physician.

"We have made great progress in national prostate cancer awareness initiatives and in reaching out to men at high risk. The treatment of prostate cancer has improved for all stages, and death from prostate cancer is declining. For many men, early detection is clearly needed, and PSA-based screening is currently the best test available. Physicians and their patients are encouraged to have the discussion to determine whether the test is right for them."
SOURCE American Association of Clinical Urologists

http://online.wsj.com/article/PR-CO-20130509-913803.html?mod=googlenews_wsj

AUA-News and Updates

News and updates from the ongoing AUA Annual Meeting via link below:

http://www.auanet.org/advnews/news-updates.cfm#open-message

Further comment from the AUA on new PSA screening guidance

Taken from The "New" Prostate Cancer InfoLink

The American Urological Association (AUA) sent the following additional message to its members with the past 90 minutes(May 6, 2013) :

Dear AUA Member,
On Friday, May 3, the AUA released a new clinical guideline on the Early Detection of Prostate Cancer. The new guideline has been in development for nearly two years and was peer reviewed by more than 50 AUA members prior to being approved by the AUA’s Board of Directors. While much of the media coverage concerning the guidelines has been accurate, some outlets have mistakenly stated that the AUA has changed its position and is now recommending against prostate cancer screening in all men at risk for this common disease. In fact, this is not at all what the guidelines state. Compared to our 2009 best practice policy document, the guidelines do narrow the age range in which informed decision making around PSA screening should be offered to men at average risk for prostate cancer, but they do not make a blanket statement against screening, as some have implied. Importantly, the guidelines only apply to men at average risk. The guidelines do not apply to symptomatic men or those at high risk for disease (men with a family history or of African-American race), who are encouraged to discuss their individual case with their doctor, regardless of their age.

Acknowledging this, there are some changes that have been made to the guidelines in response to recent new studies on screening. Specifically, in men age 40-54 at average risk for the disease, the guidelines recommend that screening, as a routine practice, should not be encouraged. Simply put, the evidence for the benefit for screening in this age range was limited while the quality and strength of the evidence regarding the harms of screening was high. This does not mean that we are recommending AGAINST screening; it simply means that there is insufficient evidence to support routine screening in this population at this time.

The other key change is in men over age 70 or those with less than a 10-year life expectancy in whom routine screening is not recommended. However, the guidelines acknowledge that some men over age 70 in excellent health may benefit from screening. In this setting, the guidelines suggest that a discussion of the unique risks and benefits of screening in older men occur.

The highest quality evidence for benefit (defined as lower prostate cancer mortality) of screening was found in men ages 55 to 69, and this evidence demonstrated that one man per 1,000 screened at 2- to 4-year intervals will avert a prostate cancer death over a decade. However, over a lifetime, this benefit could be much greater.

In men age 55-69, the guidelines still strongly recommend shared decision-making and screening based on a man’s values and preferences. The only difference here is that the guidelines now recommend biennial screening to reduce the potential harms of screening.

Additionally, it should be noted that the AUA remains in disagreement with the U.S. Preventive Services Task Force in recommendation against prostate cancer screening in all men, regardless of age or risk, without even considering a discussion of the risks and benefits of screening. The AUA continues to support a man’s right to be tested for prostate cancer — and to have his insurance pay for it, if medically necessary.

The AUA is in the process of preparing supplemental materials that urologists can share with primary care providers in their communities, and will be working with major patient advocacy groups to ensure that patient education materials are available. More information about these tools will be available in late May; the toolkit will be available on AUAnet.org.
http://prostatecancerinfolink.net/2013/05/06/further-comment-from-the-aua-on-new-psa-screening-guidance/

        

Activist Brooks changes focus to cancer detection

KANSAS CITY, Mo. — For close to 40 years, Alving Brooks has made it his mission to help the community of Kansas City in so many ways.  He told FOX 4 News Saturday that a recent health issue is turning his focus away from the adhoc group that he founded and to something that effects so many men.

Brooks spent Friday celebrating his 81st birthday and sharing a very private
part of his life.  He has prostate cancer, a disease that affects millions every year.
But many men, especially those in the African American community, don’t talk about it
and don’t get checked.  Brooks is hoping to change that.

“I have prostate cancer.  I don’t know where it stands right now,” he said.
A diagnosis was given to Brooks back in January of 2012.

“When they did biopsy of the prostrate, they found it was cancerous,” he said.  “I was surprised, because I dont eat the greasy kids stuff.  I havent eaten any meat since 1968.
Over the past year, Brooks has still been the go to man for families in need of answers.  He even held prayer vigils for the public to attend, while privately he has went through 43 treatments of radiation and some soul searching.

His goal is to move away from the adhoc group Against Crime which was started in 1977.
“I want to be able to walk away and look back and reflect how far we have come since November of 1977.  The number of people we have helped because of crime and homicide.  How we have worked with police and the courts and the community,” Brooks told FOX 4 News.

His goal is to get the word out about early detection.  Brooks lost his father to prostate cancer.  He said the move won’t happen immediately.

“I want to give it full steam ahead with this cancer thing,” he continued.  “My wife is on her second bout of cancer and at the present time at the KU Medical Center.”
“I hope I can just phase my relationship at the forefront out and be a consultant of sorts,” Brooks told FOX 4 News.  “I am looking forward to it.  I’m not going take on other task til I really ease away from it.”
“I want to give it full steam ahead with this cancer thing,” he continued.  “My wife is on her second bout of cancer and at the present time at the KU Medical Center.  I really encourage African American men when you get 45 or older — get it checked very seriously checked.”
Brooks has another appointment this month to find out about his latest cancer diagnosis.
He told FOX 4 News his wife of 63 years is also getting better and he says he can’t wait for her to come home.

According to the American Cancer Society, an estimated one out of every five African American men will be diagnosed with prostate cancer.

Studies show that this group of men and Jamaican men of African descent have the highest prostate cancer rates worldwide.  Doctors are still trying to figure out why.
More than two and a half million men in the U.S. have been diagnosed with prostate cancer and are still alive today.  That’s why early detection is so important.
http://fox4kc.com/2013/05/04/activist-brooks-changes-focus-to-prostate-cancer-detection/

USA-NEW AUA GUIDELINES-REACTION

In my opinion this is a pretty balanced set of guidelines but I've only read it through once so might add another comment below this.

*****************************************************************************
Anyway,these guidelines look set to make a lot of news so I will add a few links from various sites with their views/comments (will update  this page):

The "New" Prostate Cancer InfoLink (I'm sure they will have some views)


Urologists echo call for discussion before PSA test (Reuters India)
Urology group stops recommending routine PSA test (USA TODAY)
PSA: Urologists Say Targeted Testing Best (MedPage Today)
Prostate Cancer PSA Test: New Guidelines Issued (WebMD)

Men under 55 can skip prostate screening
Nightly News   |  May 03, 2013
After its annual meeting in San Diego, urologists recommended against screening average-risk men under 55. NBC’s Nancy Snyderman reports.

Visit NBCNews.com for breaking news, world news, and news about the economy

Early Detection of Prostate Cancer: AUA Guideline

The American Urological Association (AUA) has issued a new set of guidelines on screening for prostate cancer (as of today).Click link at BOP for full guidelines and reasons:

Early Detection of Prostate Cancer: AUA Guideline

Panel Members:

H. Ballentine Carter, Peter C. Albertsen, Michael J. Barry, Ruth Etzioni, Stephen J. Freedland, Kirsten Lynn Greene, Lars Holmberg, Philip Kantoff, Badrinath R. Konety, Mohammad Hassan Murad, David F. Penson and Anthony L. Zietman

Purpose

This guideline addresses prostate cancer early detection for the purpose of reducing prostate cancer mortality with the intended user as the urologist. This document does not make a distinction between early detection and screening for prostate cancer. Early detection and screening both imply detection of disease at an early, pre-symptomatic stage when a man would have no reason to seek medical care –an intervention referred to as secondary prevention. This document does not address detection of prostate cancer in symptomatic men, where symptoms imply those that could be related to locally advanced or metastatic prostate cancer (e.g. new onset bone pain and/or neurological symptoms involving the lower extremities, etc.).

Methodology

The AUA commissioned an independent group to conduct a systematic review and meta-analysis of the published literature on prostate cancer detection and screening. The protocol of the systematic review was developed a priori by the expert panel. The search strategy was developed and executed by reference librarians and methodologists and spanned across multiple databases. This search covered articles in English published between 1995 and 2013. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular intervention was assigned a strength rating of A (high), B (moderate) or C (low).



Guideline Statements

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. (Recommendation; Evidence Strength Grade C)
•In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C)
•For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized.

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. (Standard; Evidence Strength Grade B)
•The greatest benefit of screening appears to be in men ages 55 to 69 years.

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C)
•Additionally, intervals for rescreening can be individualized by a baseline PSA level.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C)
•Some men over age 70 years who are in excellent health may benefit from prostate cancer screening.
http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

“HG-PIN alone should not be an indication for further biopsies” in the PSA era

This is taken from 'The "New" Prostate Cancer InfoLink' website:


A podium presentation by Kingman et al. at the upcoming annual meeting of the American Urological Association (AUA) may be among the most significant to be presented at the meeting. It seriously challenges the long-held belief about the need to routinely re-biopsy men initially diagnosed with high-grade prostatic intraepithelial neoplasia (HG-PIN).

According to Kingman and his colleagues (see abstract no. 1242 in the abstracts of the AUA meeting), prostate cancer has, historically, been reported on re-biopsy in 21 to 48 percent of patients initially diagnosed with HG-PIN alone on an earlier prostate biopsy. Kingman et al. set out to determine the incidence of HG-PIN and the correlation of a diagnosis of HG-PIN to a later diagnosis of prostate cancer in a large, contemporary patient population. To do this, the authors conducted a retrospective review of their pathology database to identify all patients diagnosed with isolated HG-PIN between 2001 and 2011. These patients were then evaluated with regard to subsequent outcome, specifically identifying those with subsequent biopsies and the diagnosis of prostate cancer.

Here are the study findings:

•6,101 prostate biopsies were performed and identified 614 discrete individuals with isolated HG-PIN who had no previous abnormal prostate biopsies
•The average (median) PSA of patients at the time of diagnosis of isolated HG-PIN was 5.5 ng/ml. •Average (median) follow-up was 38.6 months.
•393/614 patients (64 percent) had at least one subsequent biopsy.
•Prostate cancer was found in 140/614 patients (22.8 percent) in total, which equates to 140/393 patients (35.6 percent) who had a subsequent biopsy.
•The average (median) PSA levels of the 393 patients who had a re-biopsy were ◦8.05 ng/ml among the patients who were positive for cancer at re-biopsy ◦6.4 ng/ml among the patients who did not demonstrate progression to prostate cancer ◦This difference was statistically significant (p = 0.016). •Among the 140 patients found to have prostate cancer at a subsequent biopsy, ◦115/140 patients (82 percent) had a primary Gleason grade of ≤ 3. ◦22/140 patients (16 percent) had a primary Gleason grade of 4. ◦3/140 patients (2 percent) had a primary Gleason grade of 5. ◦86/140 patients (61 percent) had a Gleason score of ≤ 6. ◦46/140 patients (33 percent0 had a Gleason score of 7 ◦8/140 patients (6 percent) had a Gleason score of ≥ 8.
•Average (mean) PSA levels among the 140 patients at time of diagnosis with cancer were ◦10.3 ng/ml among patients with primary Gleason grades of 4 or 5 ◦7.6 ng/ml among patients with primary Gleason grades of 3 cancer. ◦This difference was not statistically significant.
•There was no statistical difference between the patients who did or did not go on to develop cancer based on whether they had bilateral or unilateral HG-PIN on the initial identifying biopsy.

Kinman et al. conclude that, in one of the largest cohorts of HG-PIN patients reported to date,

•The subsequent incidence of cancer incidence was similar to that reported with initial PSA-driven biopsies.
•The extent of HG-PIN (unilateral versus bilateral) did not appear to correlate with a greater risk of developing prostate cancer.

Based on this information, they argue that, consequently:
•HG-PIN does not have a higher predictive value for subsequent cancer than PSA alone.
• The previous diagnosis of HG-PIN did not predict for higher-grade cancer. This leads us to the not unreasonable conclusion that the decision to re-biopsy men with an initial finding of HG-PIN should not be routine at all, but should be premised solely on a continuing rise ion the patient’s PSA level.

http://prostatecancerinfolink.net/2013/05/01/hg-pin-alone-should-not-be-an-indication-for-further-biopsies-in-the-psa-era/

A bit of history:

HGPIN: Precursor, Marker, or Meaningless? (J. Stephen Jones, MD, FACS November 02, 2010)

LATEST NEWS AND FUTURE EVENTS (Updated 12th May)

Latest News/Website Updates
Mediwatch Newsletter 2013 Q2

GENERAL,UROLOGY and CHARITY WEBSITES (Updated-12th May 2013)"


Renal & Urology News April 2013 Issue


Mediwatch Positions/Jobs

Future Events Events where Mediwatch are attending/exhibiting will be marked as so or updated,hopefully before the event is finished.More Events to add later

ASCRS 2013 Annual Meeting (USA April 27 – May 1)Mediwatch are exhibiting

AUA Annual Meeting (USA 4th-8th May)Mediwatch are exhibiting


 Mediwatch/Distributor Training Courses

Newsletters
Mediwatch Newsletter 2013 Q2
Mediwatch Newsletter 2012 Q1
Mediwatch Newsletter 2011 Q4

STUFF THAT MAYBE DID BUT NOW DOESN'T FIT IN WITH THE TITLE...