If you don't have anything you can download the MS Word Viewer free of charge. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. Prostate Cancer. Update on systemic prostate cancer therapies: Management of metastatic castration-resistant prostate cancer in the era of precision oncology. Prostate-specific antigen (PSA) is a protein made by the cells of the prostate gland. 1 This remains the case following recent large trials. For example, men aged <70 years who have a benign digital rectal exam (DRE) need two elevated PSA readings of >3 ng/mL (interval between tests 1–3 months) in additon to a free/total ratio <25% or a repeat PSA >5.5 ng/mL, highlighting the importance of repeating PSA before embarking on further investigation. Adding targeted cores to a systematic biopsy increases the detection of clinically significant cancer,6,7 although the findings are not universal.8 However, the utility is much greater for patients with a prior negative biopsy for whom a clinical suspicion remains.9. JAMA 2018;319(18):1914–31. New Medicare Benefits Schedule (MBS) Items for multiparametric magnetic resonance imaging (mpMRI) of the prostate. Can J Urol 2016;23(2):8247–53. Armstrong AJ, Szmulewitz RZ, Petrylak DP, et al. Prostate specific antigen is tissue-specific but not cancer-specific. Drost FH, Osses DF, Nieboer D, et al. Its function is to liquefy semen. N Engl J Med 2019;381(26):2506–18. Tailored information for general practices to manage Page 5/9. Nandurkar R, van Leeuwen P, Stricker P, et al. All rights reserved. The aim of this article is to review important changes in prostate cancer diagnosis and management over the past five years, particularly as they pertain to general practice. MP3 Most web browsers will play the MP3 audio within the browser, Your comment is being submitted, please wait. de Wit R, de Bono J, Sternberg CN, et al. (PRECISION) study allowed 28% of men to avoid a biopsy, but oncological outcomes have yet to be reported to indicate if this approach is safe in the long term.12 Introduction of an MRI-based triage system to prostate biopsy into one Australian public teaching hospital resulted in 47% of men avoiding biopsy altogether, with clinically significant cancers being diagnosed in 60.5% of men with a ‘positive’ MRI, and considerable savings from a healthcare perspective.15 At this stage, MRI is not recommended as an initial screening tool. James ND, Sydes MR, Clarke NW, et al. Given that recurrent disease can be detected biochemically often well before it is identifiable radiologically by CT or bone scan, treatment decisions regarding who should proceed with salvage are often imprecise, with many patients exposed unnecessarily to the morbidity of treatment without any therapeutic benefit. It is also associated with fewer biopsy cores taken and, in some studies, fewer complications.10–12 However, omitting a systematic biopsy resulted in failure to diagnose clinically significant cancer in 2.1% of patients (0.0%–12.4%),13 and a combination approach is optimal for significant cancer detection (although with higher rates of insignificant cancers diagnosed as a trade-off). Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia doi: 10.1016/j.eururo.2014.03.002. Established metastatic prostate cancer is incurable; for 80 years, castration/androgen deprivation therapy (ADT) was the standard treatment, followed by palliation once patients inevitably no longer responded (castration-resistant prostate cancer [CRPC]). Tonttila PP, Lantto J, Pääkkö E, et al. Donato P, Morton A, Yaxley J, et al. Are there any guidelines for PSA Testing? PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging has had a significant impact on decision making in this space. Clinical Practice Guidelines on PSA Testing. European Association of Urology. Department of Health. Nuhn P, De Bono JS, Fizazi K, et al. New guidelines for PSA testing have recently been published (2016). To save the file right click or option-click the link and choose "Save As...". Eur Urol 2019;75(5):743–49. In addition, upfront combinations of androgen deprivation therapy with other systemic treatments have yielded significant gains in overall survival for patients with metastatic disease. Two-thirds of Australians support pill testing at festivals: Survey. 7 The Prostate Cancer Foundation of Australia and Cancer Council Australia guidelines from 2016 recommend PSA testing every two years for men aged 50–69 years at average risk of prostate cancer. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Available at https://uroweb.org/guideline/prostate-cancer/ [Accessed 7 February 2020]. doi: 10.1016/j.eururo.2014.10.026. The current trend towards the use of lower total PSA thresholds (e.g. When a patient chooses screening, both [prostate specific antigen] PSA and [digital rectal examination] DRE should be performed. These advances include the incorporation of multiple MRI techniques (‘sequences’), such as diffusion-weighted and contrast-enhanced images, as well as the development of the Prostate Imaging Reporting and Data System (PIRADS), which is a five-point standardised reporting system for MRI-detected abnormalities, where 1 = clinically significant cancer highly unlikely to be present, and 5 = clinically significant cancer highly likely to be present.2 Higher PIRADS scores are often associated with tumours of higher volume and grade, and meta-analysis of MRI performance indicates a pooled sensitivity of 0.89 and specificity of 0.73 for prostate cancer.3 In contrast, the sensitivity of traditional imaging modalities (eg computed tomography [CT] and ultrasonography) in this setting is low. doi: 10.1056/NEJMoa1603144. The evaluation identified five relevant systematic reviews, which included a total of six randomised controlled trials Giri VN, Gross L, Gomella LG, Hyatt C. How I do it: Genetic counseling and genetic testing for inherited prostate cancer. Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Prostate specific antigen (PSA) is a glycoprotein produced solely by the prostate. anything contained in this publication. Van den Broeck T, van den Bergh RCN, Briers E. Biochemical recurrence in prostate cancer: The European Association of Urology prostate cancer guidelines panel recommendations. Supporters hope public pressure will lead to policy changes, but opponents maintain ‘no pill is safe’. is published by The Royal Australian College of General Practitioners, Family history is one of the main risk factors used by health professionals in the Australian primary care setting when as… Performing target-only biopsies increases the number of clinically significant cancers identified by 20% when compared with whole-gland sampling and consistently decreases the number of insignificant tumours detected. Elevated levels can occur in men with benign prostatic hypertrophy (BPH), prostatitis, urinary tract infection or prostatic infarction. AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. N Engl J Med 2014;371(11):1028–38. Canberra: DoH, 2018. Cabazitaxel versus abiraterone or enzalutamide in metastatic prostate cancer. 1 more confidence, whether the elevated PSA is more likely to be associated with prostate cancer than be due to non-cancerous changes, potentially avoiding unnecessary biopsy. ARCHES: A randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. Prostate specific antigen (PSA) is a glycoprotein produced solely by the prostate. It makes recommendations on how best to support men in making an informed decision for or against PSA testing and on which testing protocol to recommend to men who decide in f… The guidelines were published in January following the National Health and Medical Research Council (NHMRC) approving the guidelines’ recommendations. The Netherlands: EAU, 2019. Omission of biopsy is recommended only in low-risk cases and should be based on shared decision making with a well-informed patient.16, One important consideration for the use of MRI is the potential for variability among readers (reporting radiologists).An agreement rate of 78% between central and local reports seen in one large multicentre randomised trial,12 reinforces the importance of ensuring scans are performed and reviewed at experienced centres.9. Screening of asymptomatic (low-risk) men for prostate cancer by prostate specific antigen (PSA) testing is not recommended because the benefits have not clearly been shown to outweigh the harms. Patients should be aware that testing may have insurance implications, highlight the risk of other cancers (that the patient may not anticipate) and identify variants of unknown significance that require ongoing follow-up in case they are revealed to be important at a later date. Prostate Cancer Foundation of Australia and Cancer Council Australia: Sydney, 2016. Elevation also may occur after prostate biopsy, aggressive digital rectal examination (DRE), ejaculation, bicycle riding and physical exercise. BJU Int 2018;122(5):783–93. Eur Urol 2016;69(3):419–25. Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-specific antigen-based screening for prostate cancer: Evidence report and systematic review for the US preventive services task force. Prostate specific antigen is tissue-specific but not cancer-specific. doi: 10.1200/JCO.19.00799. N Engl J Med 2015;373:737–46. Early reports suggested that detection of a particular splice variant of the androgen receptor (ARv7) in circulating tumour cells may identify patients who are resistant to androgen signalling–targeted inhibitors.30 However, this process has produced mixed results in validation studies31 and is not widely used clinically. ABSTRACT: An association between age and prostate-specific antigen (PSA) has been documented: As men age, their serum PSA value increases. Nat Rev Urol 2016;13(3):151–67. College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation.7 The Prostate Cancer Foundation of Australia and Cancer Council Australia guidelines from 2016 recommend PSA testing every two years for men aged 50–69 years at average risk To help men have an informed discussion with their GP about the risks … Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: Results from a randomized prospective blinded controlled trial. For the purposes of this evaluation, PSA testing refers to PSA testing with or without DRE. Australian Family Physician (incorporating Annals of General Practice) It can help to diagnose and monitor prostate disease. Another area of interest is whether MRI can be used as a triaging tool. Eur Urol 2017;72(2):177–88. Low levels of PSA are normally present in the blood but as a man gets older, the prostate often grows and the level of PSA gets higher. The American Urological Association, European Association of Urology and The Urological Society of Australia and New Zealand all recommend screening. doi: 10.1111/bju.14374. Tannock IF, de Wit R, Berry WR, et al. Referral to a genetic counsellor for assessment, and to provide patients with information to determine if testing is right for them and their families, is important. Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: A systematic review. Eur Urol 72(2):250–66. Early detection with molecular imaging may allow these sites to be specifically targeted with local treatment, thus avoiding or delaying the need for systemic therapy. Journal of Pritchard CC, Mateo J, Walsh MF, et al. Australian These will have "DOC" in brackets along with the filesize of the download. A systematic review and meta-analysis from the European Association of Urology prostate cancer guidelines panel. doi: 10.1016/j.eururo.2017.02.026. doi: 10.1001/jamaoncol.2019.0096. Clin Genitourin Cancer 2019;17(4):275–82.e1. Finally, however, Australian consensus guidelines – Clinical Practice Guidelines for PSA Testing and Early Management of Test-Detected Prostate Cancer – were published in January this year with the aim of putting an end to the confusion. It employs a predefined program of regular monitoring (with PSA, DRE and repeated biopsy) to allow for delayed intervention at a stage when the disease is still potentially curable. Urol Oncol 2015;33(1):17.e1–17.e7. doi: 10.1016/j.euf.2019.06.004. Panebianco V, Barchetti F, Sciarra A, et al. Prostate Cancer Foundation of Australia and Cancer Council Australia. taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or effectiveness of prostate-specific antigen (PSA) testing of asymptomatic men in reducing mortality and morbidity from prostate cancer5. When considering the interpretation of MRI, it is imperative to consider the individual patient’s risk of prostate cancer based on their family history, PSA and DRE. A total PSA threshold of 4.0 ng/mL has traditionally been used as the criterion for prostate biopsy. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study. For example, abiraterone might be less preferable in a patient with diabetes who has poor glycaemic control because of the need for concomitant steroids. If you do not have it you can download Adobe Reader free of charge. The management of prostate cancer has changed significantly in recent years, particularly the use of imaging, with the introduction of prostate magnetic resonance imaging as routine in the diagnostic pathway, and the increasing use of prostate-specific membrane antigen positron emission tomography for early stratification in the salvage setting for failure of primary treatment in localised disease. Eur Urol 2019;76(3):340–51. Eur Urol 2017;72(2):282–88. In asymptomatic men without a diagnosis of prostate cancer, a single total PSA test result above 3.0 ng/mL identifies three-to-four times as many men who do not have prostate cancer on … doi: 10.1016/j.eururo.2015.05.024. Chi KN, Agarwal N, Bjartell A, et al. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. MRI-targeted or standard biopsy for prostate-cancer diagnosis. Prostate cancer resource. doi: 10.1056/NEJMoa040720. JAMA Oncol 2019;5(6):856–63. For patients who were initially treated with ADT alone, those with progressive CRPC may be offered either chemotherapy (docetaxel) or androgen signalling–targeted inhibitors on the basis of multiple factors including previous response to ADT, fitness for chemotherapy and specific patient factors (Table 2). PSA testing and early management of test-detected prostate cancer: Clinical practice guidelines. Family history of prostate cancer with onset younger than 65 years has been found to be associated with an increased risk of prostate cancer in a number of international cohorts. These files will have "PDF" in brackets along with the filesize of the download. doi: 10.1016/j.eururo.2016.08.041. doi: 10.1016/j.eururo.2018.03.028. The Royal Australian College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation. The PSA testing guidelines published by the Prostate Cancer Foundation of Australia/Cancer Council Australia (and endorsed by the National Health and Medical Research Council) contain detailed information about who should be offered PSA testing and the supporting evidence. For the first time, these guidelines provide health professionals access to evidence-based recommendations for using the prostate specific antigen (PSA) blood test to assess prostate cancer risk and manage test-detected patients. Active surveillance aims to defer curative treatment for patients with low-risk, clinically localised prostate cancer to minimise treatment-related toxicity without compromising survival. General All Sections Clinical Professional Racgp GP Opinion Videos & Podcasts. Every care is doi: 10.1016/j.urolonc.2014.09.013. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Its function is to liquefy semen. A PSA test measures the amount of PSA in the blood. Files on the website can be opened or downloaded and saved to your computer or device. doi: 10.1056/nejmoa1801993. The guidelines have also received formal endorsement from the Urological Society of Australia Where To Download Racgp Guidelines type 2 diabetes. doi: 10.1016/j.clgc.2019.04.013. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. 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