Dr Chris Parker

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Dr Chris Parker Senior Lecturer and Honorary
Consultant in Clinical Oncology Institute of
Cancer Research and Royal Marsden Hospital London
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Screening a Distant Dream? Dr Chris
ParkerCancer Research UK Clinician
ScientistRoyal Marsden Hospital and Institute of
Cancer Research
South of England Prostate Cancer Collaborative
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US public opinion on screening
Schwartz et al. JAMA 2004
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What would an ideal prostate cancer test
do?How can we develop an ideal prostate cancer
test?
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An ideal screening test
100
Risk of disease
0
Test result
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The PSA test is far from ideal for screening
Risk of prostate cancer ()
PSA level (ng/ml)
Thompson et al. JNCI (2006)
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Thompson et al. JNCI (2006)
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What would an ideal prostate cancer test
do?How can we develop an ideal prostate cancer
test?
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Not all prostate cancers are created equal
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What would an ideal prostate cancer screening
test do?

• avoid unnecessary treatment by identifying men
  with cancers that actually need to be treated
• avoid unnecessary diagnosis by helping to
  identify who should or should not undergo
  prostate biopsy

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Risk of prostate cancer Risk of high-grade
prostate cancer
Thompson et al. JNCI (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
61 yr old white man, 40 ml gland, DRE normal, PSA
10 37 risk
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
61 yr old white man, 75 ml gland, DRE normal, PSA
10 lt 10 risk
Nam et al. Can J Urol (2006)
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Nomogram prediction for any prostate cancer
61 yr old white man, 75 ml gland, DRE normal, PSA
10 20 risk
Nam et al. Can J Urol (2006)
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Nomogram prediction for Gleason gt 7 prostate
cancer
Ideal screening test
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The PSA test is far from ideal for screening
100
Risk of prostate cancer
0
PSA level
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The current situation
100
Risk of high-grade prostate cancer
0
Nomogram score
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A distant dream
100
Risk of tiger
0
Nomogram score
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What would an ideal prostate cancer screening
test do?

• avoid unnecessary treatment by identifying men
  with cancers that actually need to be treated
• avoid unnecessary diagnosis by helping to
  identify who should or should not undergo
  prostate biopsy

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What would an ideal prostate cancer test
do?How can we develop an ideal prostate cancer
test?