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