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Epidemiology and risk factors (NCJM 2003:34*366)

• Most common cancer in U.S. men; 2nd most common cause of cancer death in men

• Lifetime risk of prostate cancer dx 16%; lifetime risk of dying of prostate cancer 3%

• More common with 1 age (rare if <45 y). in African Americans, and if © FHx

Clinical manifestations (usually asymptomatic at presentation)

• Obstructive sx (more common with BPH): hesitancy, i stream, retention, nocturia

• Irritative sx (also seen with prostatitis): frequency, dysuria. urgency

• Periprostatic spread: hematuria, hematospermia. new-onset erectile dysfunction

• Metastatic disease: bone pain, spinal cord compression, cytopenias

Screening (NEJM 2001:344:1373)

• Mortality benefit from screening has not been established (Annoh 2002:137:915.917)

• Digital rectal exam (DRE): size, consistency, lesions

• PSA: 4 ng ml cutpoint neither Se nor Sp; can t with BPH. prostatitis, acute retention, after bx or TURP. and ejaculation (no significant t after DRE, cystoscopy)-, i free PSA %, T PSA velocity. T PSA density. & age-adjusted PSA reference ranges may T test utility 15% of men 62 y w PSA 4 & nl DRE have bx-proven T1 cancer {NQM 2004:3502239) ■ • Offer DRE • PSA screening to men age ^50 (¿=45 if high risk) with life expectancy -10 y

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