esecuzione di un PSA
Transcript
esecuzione di un PSA
Esiste un p paziente asintomatico al quale q consigliare l’ l’esecuzione di un PSA ? Giacomo Novara Novara, M M.D., D F F.E.B.U. EBU Assistant professor Associate editor European Urology U l Urology Cli Clinic, i U University i it off P Padua d [email protected] Heidenreich A et al. Eur Urol 2013; 64: 347 - 354 Siegel R et al. CA Cancer J Clin 2013;63:11–30 Center MM et al. Eur Urol 2012; 61: 1079 - 1092 Center MM et al. Eur Urol 2012; 61: 1079 - 1092 Major findings of ERSPC • The benefit of screening becomes more evident as followup increases, with a RR reduction of 38% in men with a follow-up of 10–11 yr. • There was no indication of a mortality reduction in men 70 yr of age, so this upper age limit or life expectancy 10 yr warrants careful consideration in future screening programmes. Schroder FH et al. N Engl J Med 2012;366:981-90 Major findings of ERSPC Hugosson J et al. Lancet Oncol 2010; 11: 725–32 Major findings of ERSPC • Most of the benefit from screening occurs after 10 yr of follow-up • PSA screening in all men 70 yr of age appears to be questionable • Screening might result in the detection of fewer locally and systemically advanced PCa cases, which enables less aggressive treatment with fewer side effects Hugosson J et al. Lancet Oncol 2010; 11: 725–32 Major findings of ERSPC Daskivich T, et al. Ann Intern Med. 2013;158:709-717. Lyfe expectancy and health state in Italy Stato di salute riferito Età cronologica Eccellente Buono Discreto Cattivo 65 20 16 13 10 70 17 12 10 7 75 14 9 7 5 80 10 7 5 4 Men at potentially significant risk of prostate cancer mortality • Men with long life expectancy • Men without significant comorbidity Higher risk categories • African-American • Men with father, brother, or son with prostate cancer (especially if it was found at younger age) • PSA-based PSA based assessment of risk Higher risk categories Vickers A, et al.BMJ 2010;341:c4521 Higher risk categories Vickers A, et al. BMJ 2010;341:c4521 Prostate Cancer Prevention Trial risk calculator http://deb.uthscsa.edu/URORiskCalc/Pages/calcs.jsp Prostate Cancer Prevention Trial risk calculator http://deb.uthscsa.edu/URORiskCalc/Pages/calcs.jsp ERSPC risk calculator http://www.prostatecancer-riskcalculator.com/assess-your-risk-of-prostate-cancer ERSPC risk calculator 1 (no PSA) http://www.prostatecancer-riskcalculator.com/assess-your-risk-of-prostate-cancer ERSPC risk calculator 2 http://www.prostatecancer-riskcalculator.com/assess-your-risk-of-prostate-cancer