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Prostate 2.0

Casey Parker, MD
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Casey Parker synthesizes the recommendations from prostate cancer screening guidelines around the world and provides us with a patient centred approach. He recommends providing patients with paper handouts or web sites with clear and realistic data about screening. At a follow-up visit, the harms and possible benefits of screening can be discussed and a shared decision can be made. While the current best evidence does not support the use of PSA (or DREs) in prostate cancer screening, providers need to also factor in patients’ concerns and fears.  He also reviews the PROTECT and PROMIS trials and how these findings should impact the evaluation of potential prostate cancers.


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Ian L., Dr -

10-15% of prostate cancers will be aggressive Gleeson Score greater than six and for those with Gleeson Scores 7-10 treatment extends life .
Currently it is indicated that there are genetic causes for prostate cancer eg BRAC genes AfroAmericans Ethnicity and lifestyle factors obesity heavy drinking smoking sedentary life style diet high in meat .
Importantly Transrectal biopsy is being replaced by TransPerineal biopsy : Transrectal biopsy has a 2% incidence of sepsis but it is far less with TransPerineal.

Reference : Sepsis and SuperBugs : Should we favour transperineal biopsy over the transrectal approach for prostate biopsy Grummetet al Urological Oncology September 2014 pg 384-388.

Heidi J., MD -

Thanks for this, Ian!

Jennifer A. -

Is there a good PDF handout reference for patients that discusses risk vs. benefit of PSA testing?

Mordechai S. -

That's what I'm trying to find as well.

Madeleine Z. -

Not a handout, but here is a video (The Prostate Specific Antigen (PSA) Test by Dr Mike Evans)

Heidi J., MD -

Oh, we love Dr. Evans' videos! Thank-you for sharing :)

Heidi J., MD -

Hi! While it's not a pdf, Casey's blog has some patient-friendly info.

Emily M. -

I have found this handout helpful with patients.

Heidi J., MD -

Thanks Emily - this is helpful!!

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Legions of Lesions Full episode audio for MD edition 172:45 min - 81 MB - M4AHippo Primary Care RAP June 2017 Summary 12 MB - PDF