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Home My WebLink AboutItem B - Written Communications ifr�» �? � ■ , 1 1 � In ihe Clininl Consideratloos section ot Ihe Guidelines,the CSPSTF has clarified that its recommendation allows for • � , , • / discussions between clinicians and patients to promote informed decision maAing[hat supporls personal rslues • � � � � � . � � , and preferences. PLEASE REVIEW THE 10 PATIENTQUESTIONS AND ANSWERS ON THE REVERSE SIDE 1. Some aggressive prostate cancers produce only small 6. A large European randomized trial of screening vs. no amounts of PSA and therefore DRE's should always be screening (ERSPC)found a 21-29% reduction in prostate performed in addition to the PSA test. Prior to the blood cancer mortality risk through PSA screening. (Schroder, draw, the physician should tell the patient that the physician NEJM 2012)A randomized triai in the U.S. (PLCO)found is only looking for potentially lethal prostate cancer. no benefit—but 79% of the men in the "usual care"arm of this study received at least one PSAtest, so[he trial 2.After obtaining an initial PSA for a patient, the physician authors concluded that the trial shows only that annual should refer to guidelines that stratify the patienYs risk for screening offers no clear benefit over ad hoc PSA testing life-threatening prostate cancer. Frequency of future PSA associated with routine primary care. (Andriole, JNCI 2012) testing depends on that risk assessment. Thus the PLCO does not contradict the ERSPC, and there (www.mskcc.org/cancer-care/adulUprostate/screening- really should be no controversy about the fact that guidelines-prostate) screening saves lives. 3. Having a father or brother with prostate cancer more 7. Risk of infection with a biopsy is minimized when the than doubles a man's risk of developing prostate cancer. patient pre-medicates with antibiotics; and pain from a The risk is greater for men with several affected relatives, biopsy should be minimized with anesthetic compounds. especially young relatives. Men who eat a lot of red meat or dairy products seem to have a higher chance of developing 8. Most prostate cancers found today are low-risk and do prostate cancer. Other possible risk factors include obesity, not require treatment.Active Surveillance (AS) is an prostatitis, STD's, exposure to Agent Orange and Iack of accepted alternative for low-risk, non-aggressive prostate exercise. cancec Currently there are tools, including genomic tests, that help determine who is an appropriate candidate for 4. To determine if a biopsy is warranted, asymptomatic AS. Overtreatment of low-risk disease does remain patients with a high PSA and at least a 10-year life prevalent in the U.S., however, and patients should be expectancy should have a repeat PSA. Afree calculator referred to urologists who understand risk stratification of (http://tinyurl.comlcaprisk)can integrate PSA, age, fami�y prostate cancer and who routinely offer the surveillance history, and other factors to generate risks of prostate option to men with Iow-risk disease. cancer diagnosis and high-risk cancer diagnosis. Other tests used in some cases include free-versus-bound PSA 9. When cancer has progressed to the point that symptoms and the PHI aigorithm. (Journal of Urology Volume 185, are present, the disease has usually spread and is no Issue 5, Pages 1650-1655, May 2011) longer curable. 5. Since the 1990s when PSA testing became widespread, 10.A man cannot begin to make any decision about his there has been a >40% decline in prostate cancer mortality. prostate health without knowing his PSA and keeping track (American Cancer Society). Most of this decline can be of any changes. Focusing testing on men at highest risk of attributed to screening efforts and improvements in iife-threatening disease helps balance the potential benefits treatment for high-risk disease detected early through and harms of screening. screening (Etzioni Cancer Causes Control 2008). pSA testing is current/y a man's best defense against dying of potentia/ly lethal prostate cancer and against deve/oping metastatic prostate cancer. Individuals have a fundamental right to choose whether or not they want to know if they have prostate cancer, p�ior to becoming symptomatic. www.prostatecalif.org � � California Prostate Cancer Coalition `A"`°""'" Prostate ReviseU 5-22-15 �2074 by Califomia Prostate Cancer Coalifion.All rights reserved 0 Cancer COALITION � ■ , � � • � � � � � � � � � � � � � ' There is much debate on the value of PSA testing and the diagnosis of prostate cancer. 10 QUESTIONSTOASKYOUR DOCTORABOUTYOU AND PROSTATECANCER 1. I want to know my risk for developing aggressive 6. What are the risks of NOT detecting an aggressive or prostate cancer. What tests are there to leam my risk? potentially life-threatening prostate cancer early? The two basic methods for determining your risk for It will be more difficult, even impossible, to cure. Once the developing aggressive, life-threatening prostate cancer are cancer escapes the prostate it can invade the lymph nodes the prostate specific antigen (PSA)blood test and the and may spread to the bones and elsewhere (metastasis). digital rectal exam (DRE). 7. What are the risks of a biopsy? 2. What is a "baseline PSA" and what is the value of a There is a risk of bleeding which is usually minor, and of an "baseline PSA"? infection, which is reduced through pre-biopsy antibiotics. A base�ine PSA is your initial PSA blood test at about age The other risk is diagnosing an insignificant rancer. Most 40 that allows you and your physician to watch how your men would think this is worth the risk, but this is a personal PSA varies over time. decision. 3. What is the impoRance of family history, ethnicity and 8. If I have a biopsy and it reveals cancer, do I necessarily exposure to Agent Orange? have to have treatment? What is "Active Surveillance"? A family history of prostate cancer, especially in a first- You do not necessarily have to have treatment. If a degree relative (father, brother, son), increases your risk of relatively low-risk cancer is found, you may be a candidate developing prostate cancer. Certain ethnicities also carry a for Active Surveillance, (AS), under which PSA and other high risk of developing aggressive prostate cancer, i.e., tests are performed periodically to ensure that you receive African-American men have approximately twice the timely treatment, if necessary. incidence and death rate from prostate cancer as Caucasian men. Prior exposure to Agent Orange may also 9. Why shouldn't I wait until I have urinary or other increase the risk of developing aggressive prostate symptoms to have my first PSA? cancer. When cancer has progressed to the point that symptoms are present, the disease has usually spread and is difficult 4. If I have a PSA test and it comes back high, what other or impossible to cure. tests are there that I can have to determine if I need a biopsy? 10. If I am willing to live with the potential side effects of a Your physician will want to rule out an infection and/or an biopsy or of treatment, shouldn't the decision be mine? enlarged prostate, both of which can cause the PSA levels Weighing side effects of any possibie testing, diagnosis and to increase.A repeat PSA should be obtained. There are treatment against the chance of living a full life is a very other tests such as free PSA, PCA3, PHI and others which personal decision based upon your own values. Most men may be useful in some instances. Free calculators can help would at least like to know if they have prostate cancer. integrate your PSA with your age, family history, and other Then you can make a joint decision with your physician as parameters to estimate your risk of prostate cancer and to what steps, if any, to take. high-grade prostate cancer. See http://tinyurl.com/caprisk. PSA testing is currently a man's best defense against dying 5. What are the benefits of detecting aggressive or of potentially lethal prostate cancer and against developing potentially aggressive prostate cancer early? metastatic prostate cancer. Individuals have a fundamental As with most cancers, the earlier aggressive prostate nght to choose whether or not they want to know i(they cancer is diagnosed the greater the chance that the cancer have prostate cancer. prior to becoming symptomatic. will stiA be confined to the prostate and thus curable. Knowledge is Power! www.prostatecalif.org p, p , CAIIFORNIA California Prostate Cancer Coalition Prostate Revised 522-75 �2074 by Cali/omia Prostate Cancer Coalition.Ali nghts reserved. �{� Cancer COAIITION