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7/23/2019 PSA Great Hoax
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in 2012 US perventive services task forcerecommended against psa screening on the groundthat there is no net benefit and that the potential
harms outweight the benfitt.
AUA outraged at this decision, criticized aspremature in a rapidl evolving area of intensive
research
!he great prostate "oa#?
$r. %ddu.s.srinadh&'(S, )%*U, &.S,. &.(h,$+*
*adr al sama group of hospitgals&uscat
Sultanate of oman
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SA or +o SA -
)orgive !hem for !he now /hat +ot !he $o
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6 7 Y R S
A S I A NP S A D O N E A S A R O U T I N E S C R E E N I N G D U E T O A G E
N O F A M I L Y H / O P R O S T A T I C C A N C E R
O N E N Q U R Y A D M I T T E D O F H A V I N G L U T S
I P S S S C O R E : 6
U R O F L O W M E T R Y ; Q . M A X : 6 M L / S C
D R E : N O R M A L
U S S ; N O R M A L
P S A : 8 . ! 8 . " ! 6 . # . ! 6 . 8 . ! 8 .
M R I : L T L T E R A L S M A L L C O C I A P I C A L L E S I O N $ C M
C Y S T O S C O P Y : S H O W E D M E D I A N L O % E E N L A R G E M E N T
U S S G U I D E D % I O P S Y : A T Y P I C A L S M A L L A C I N A R P R O F I F E R A T I O N
(ase no1
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(ase no 2n enuir
345m Arab6ncidentall found increased psa+o 7U!S$'%8 normal
sa84.9. 9.:, :.0
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/ent to india
Underwent &'6
&'6 showed multiple nodulalr lesions in the tranasitional zone ,
+o evidence of malignanc
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% I O P S Y M O S T O F T H E C O R E S A R E % E N I G N
E X C E P T O N E C O R E S H O W E I N G A S A P
Underwent ultrasound guided
biops
7/23/2019 PSA Great Hoax
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sa8:,1:,;
<.4<.::.1
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'ichard =. Ablin h.$. first observed the antigen SA fort earsago. !. &ing (hu of the 'oswell ark (ancer 6nstitute developed
the process to test for it. Urologists (ooner and Scardino did theclinical studies that resulted in the recommendation thatscreening,
6 then happened upon the 'obert *. Ablin )oundation for (ancer'esearch.
!he )oundation is dedicated to Ablin>s father 'obert who died ofprostate cancer. n the surface it all fits together uite nicel? thediscoverer of S
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SA
'ichard @ Albin6mmunologist*ufallo
1490(rosurger for carcinoma of prostate
!. &ing chu biochemist from bufallo
!he American Association for (ancer 'esearch cited SA as one of the7andmark Scientific $iscoveries of the
20th (entur
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"britech
Sandiago
(ommercialized
1443 8)$A approved
Strongl propagated b
/illliam catalona
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W&''&() *(+(',-(
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opulation or mass screening is defined as thesstematic e#amination of asmptomatic men Bat
risk C.
%ver ear ; billion dollars spent on psa screening
*ut things changed
eople started uestining its value
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O- )(- &- &0 1&'' 2 3&(4-,3 1&+5,+(+ *(-* 3&-4 5& '&9+&)! 2+ ,-',- )(- &- " 1&'' 3& 9,) &+.
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/h did he do so
!he discover of the psa himself turned againistitBcreator became the destroerC
According to him
SA is not cancer specific+o natural cut off point
6t can not defferentiate latent cancer , non clinicalcancer and aggressive cancer
(a prostate is a age related cancer, if ou do biopsin aged populationB<0D90 rsC <0 E of them willhave ca. prostate
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/hat he sas
SA screening is a public health disaster
Use of SA testing for screening of prostatic cancer
in asmptomatic men was strictl for mone and alots of mone.
6t is a wish to defect cancer at an cost and imperfect
understanding of how psa works
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rostatic cancer is a age relateld cancer
%#?if ou do biops between <0D90 rs age groupabout <FE of them had cancer
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S*-&-4 (-3 P,+(+ C(-* M,+('&+: R'+ ,9 +5 E,(- R(-3,)&3 S+3,9 S*-&-4 9, P,+(+ C(-* <ERSPC= (+ " Y( ,9 F,'',1>U<L(-*+ (4! @=
6n this update the %'S( confirms a substantialreduction in prostate cancer mortalit attributable to
testing of SA, with a substantiall increasedabsolute effect at 1; ears compared with findingsafter 4 and 11 ears. $espite our findings, furtheruantification of harms and their reduction are still
considered a prereuisite for the introduction ofpopulatedDbased screening.
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G6magination is more important than knowledge. )orknowledge is limited to all we now know andunderstand, while imagination embraces the entire
world, and all there ever will be to know andunderstand.
H Albert %instein
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18 F, )- (43 @B6#! &3-* 3),-+(+ +5(+ PSA ++&-4 3*
,+(+ *(-*>*&9&* ),+('&+ (-3 +5 &-*&3-* ,9 )+(+(+&* ,+(+
28 P,+(+ *(-* 3&(4-,& )+ 2 -*,'3 9,) ,+(+ *(-*
&-+-+&,-.
". PSA ++&-4 5,'3 -,+ 2 *,-&33 ,- &+ ,1-! 2+ (+5 ( (+ ,9 ()'+&(&(2' (,(*5 +, (' ,+(+ *(-* 3+*+&,-.
. O'3 )- &- 4,,3 5('+5 1&+5 +- ( '&9 0*+(-* 5,'3 -,+ 2
3-&3 PSA ++&-4 ,- +5 2(& ,9 +5& (4.
F. %('&- PSA ++&-4 9, )- &- +5& @ & 9' 9, 3&*+&-4 +59+ & ,9 ,+(+ *(-*.
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Iuideline of guidelines ?psa screeningJ*=U6 october 2013
T5 U-&+3 S+(+ P-+& S&* T( F,* <USPSTF=!he USS!) is a group of health e#perts that makes recommendations
about preventive healthcare
. 6n 200:, this group recommended against SA screening for men agedK9F ears
6n 2012, the USS!) updated their literature review and instead issued aIrade $ recommendation against prostate cancer screening for men of allages L
!he rationale that the gave for this8
is that for ever 1000 men screened, there would be onl one fewer
prostate cancer death
but ;0M30 men with incontinence or erectile dsfunction due totreatment, two with serious cardiovascular events, and one with venousthrombosis.
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G&3'&- ,9
4&3'&-
'andomised trials have shown thatSA screening reduces metastatic
prostate cancer and diseaseDrelateddeath.
!he USS!) recommends against SAscreening, while most other
professional organisations recommendshared decisionDmaking about SAscreening.
SA screening should be discontinuedfor men with N10Dear life e#pectanc.
Several guidelines now recommend baseline SA testing for men in hteir30s for risk stratification