Prostate Cancer

Marc B. Garnic, MD, addresses these questions in this short video. Dr Garnic, who spoke on this topic at the 2011 American College of Physicians meeting in San Diego

Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.

Benign prostatic hyperplasia (BPH)-histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate-affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.

To screen or not to screen? The answer is not straightforward when it comes to prostate cancer. Recently updated guidelines from the US Preventive Services Task Force (USPSTF) recommend against prostate- specific antigen (PSA) screening in men who are 75 years and older and state that there is insufficient evidence to confirm whether screening is beneficial-or harmful -to men younger than 75 years.1,2 The recommendations are summarized in the Table.

BOSTON -- Older male clinicians are more likely than others to order inappropriate prostate specific antigen (PSA) tests, researchers here said.

ANAHEIM, Calif. -- Testosterone levels appear to have a major influence on PSA values and may warrant watching for patients at high risk of prostate cancer, a large screening program suggests.

ANAHEIM, Calif. -- A single PSA measurement in middle age can predict a prostate cancer risk up to 25 years later, a Swedish researcher reported here.

KISSIMMEE, Fla. -- After definitive prostate cancer therapy, there is little value in imaging studies when patients with biochemical failure are asymptomatic and have PSA levels less than 5 ng/mL, researchers here reported.

KISSISSIMEE, FLA. -- Escalated-dose conformal radiotherapy for localized prostate cancer was associated with a 34% reduction in the relative risk of biochemical failure in a randomized trial of 843 men also with treated with androgen deprivation therapy.

My patient is a 78-year-old man who complains of severe exhaustion, lack of energy,and hot flashes.