Q7. Adjust Screening Thresholds Based on Treatment Strategy?
- Deferring side effects of treatment are a benefit of delay.
- Treatment strategies with active surveillance if appropriate and possibly focal therapy reduce risk of side effects.
- Reduced risk of side effects can decrease your threshold for biopsy, possible MRI and other screening actions.
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Biopsy and Treatment Risk Assessment Adjustments
How might you adjust screening thresholds for active surveillance or possibly focal therapy and also for biopsy consequences?
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Personal Risk Assessment for the If-Cancer Case
Question 1. Biopsy Now or Delay Informed by Analysis? explored the consequences of biopsy delay and process for balancing them. See Q1. Biopsy Delay.
Highlights are presented below for convenience. |
Consider Consequences of Biopsy, Diagnosis and Treatment
A biopsy of the prostate is the pivotal cancer screening step. It is needed to diagnose cancer that can lead to treatment with possible life saving benefits. However, most prostate cancers are not very life threatening with little or no benefit of treatment.
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A biopsy also has negative consequences, including:
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Consider Average Outcomes for a Delayed Biopsy
The bullets show average reductions in life expectancy from a 1-year delay in biopsy, possible diagnosis and treatment if warranted both: 1) Overall and 2) If-cancer is found for the estimated probability a biopsy will find cancer:
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CAUTION: These are estimated reductions in life expectancy from delay based on the example cancer growth rate. They are in addition to any decreases in life expectancy from prostate cancer that is diagnosed now with treatment that may not be successful.
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Assess Personal Risks for "If-Cancer" Case
Your biopsy timing decision should be based on your assessment of risks. The decision is very personal with wide variation among men and among physicians with potentially large differences between men and their physicians. For example,
On the Right: Diagnosis and Treatment Deferral Benefit for the "If-Cancer" Case: |
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Biopsy Risk Assessment Adjustment
Highlights of the Example case in Appendix B of our free Sample Report are presented below.
Deferring the discomfort of a biopsy and the risk of potentially life-threatening sepsis (infection) is the additional benefit of a 1-year delay:
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Treatment Risk Assessment Adjustment
There is a chance that the prostate cancer found by biopsy is indolent and suitable for active surveillance rather than primary treatment (surgery or radiation). Active surveillance is increasingly used because it reduces the side effects of treatment. If you plan active surveillance of indolent cancer if diagnosed then you should consider reducing the diagnosis and treatment deferral benefit somewhat.
Focal therapy is a new family of treatments with reduced side effects that try to destroy tumors with little or no damage to the surrounding prostate tissue. Long term effectiveness of focal therapy has not been proven. Reduce your biopsy threshold further if you plan focal therapy for appropriate cancers.
Highlights of the Example case in Appendix B of our free Sample Report are presented below.
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Net Adjusted Benefit of Delay
For the Example, there was a net increase in probability adjusted benefit of delay risk percentage:
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When done with Question 7, continue to Q8. Collaborative Team
Alternatively, return to Free Questions and Answers