PSA Screening for Prostate Cancer

Up Coming Events
Canadian Urological Association
61st Annual Meeting
June 25 - June 28, 2006
World Trade & Convention Centre
Halifax, NS
Canadian Nurse Continence
Advisors Association
5th Biennial Conference
A Publication of the Urology Nurses of Canada
PSA Screening for Prostate Cancer
“Challenges of Continence...
Applying Best Practice”
May 5 – 6, 2006
Inn at the Forks,
Winnepeg, MB
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Urology Nurses of Canada
at the CUA meeting
Monday, June 26, 2006
16.00 - 18.00 hrs
Casino Nova Scotia Hotel
Halifax, NS
Phone: 204-235-3505
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Sue Hammond, RN
The Pipeline is a publication of
the Urology Nurses of Canada.
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Annual Symposium
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New York, NY, USA
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Estimates show that this year more than 20,500 Canadian men will be diagnosed
with Prostate Cancer and over 4,300 will die from it. The gold standard for
Prostate Cancer screening is the Prostate Specific Antigen (PSA) blood test
accompanied by a digital rectal exam (DRE). Since the introduction of PSA
testing in the late 1980s there has been much controversy and debate over its use
in wide spread screening programs.
The Pipeline is published each
winter and summer for UNC members
Canadian Prostate Cancer Network
3rd Annual Meeting
July 30 - August 1, 2006
Calgary, AB
December 2005
May 1, 2006
Prostate Specific Antigen is a member of the kallikrein gene family and functions
as a serine protease secreted into the seminal fluid to help with seminal
liquefaction. It is only produced in any significant quantity by the prostate
epithelium and the periurethral glands.
PSA appears in both free and complex molecular forms in the blood. The complex
PSA binds to alpha-1-antichymotrypsin and is higher in men with prostate cancer
Several factors that affect PSA are:
Prostate cell number
Prostate size
Recent ejaculation - effected 6-48 hours
Prostate manipulation
Vigorous massage – effected 1 week
Cystoscopy – effected 1 week
Prostate Biopsy – effected 4-6 weeks
Prostatitis
Acute – effected 3-6months
Chronic
Drugs: Finasteride (Proscar)
effected 3-6 months
lowers PSA for as long as the
patient is on the medication
Pipeline Editor:
Sue Hammond:
Tele: 709-368-0101
Email: [email protected]
When screening is undertaken some general principles apply. A population for
whom screening is appropriate must be defined. Sensitivity and specificity should
be high and there should be a prevalence of the disease with a high fraction of
undesirable consequences. The natural history of the disease should be known.
Treatment must prevent the unfavorable consequences of the disease and costs
and benefits reviewed.
There are 3 types of screening at present:
Screening – this involves testing of the total population
Early Detection – screening on request of the well informed
Opportunistic screening – this screening is done outside given protocol in
randomized trials and can be a contaminate in results.
Continued on page 2
Page 8
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Continued from page 1
CPCN Conference
Dr G, Duffy, 2005, Prostate Cancer
PSA screening usually starts at age 40-45 with a family
history of first degree
www.columbia.edu/news/press_releases/PSA_test.html
If there is no family history of prostate cancer then
screening starts at 50 and continues to 75 or when a
patient has less than a 10 year life expectancy.
www.unc.org/may5.htm
Prostate Cancer risk factors need to be taken into account
when interpreting PSA results. These include age, race,
family history, hormone profiles and concomitant
medical conditions.
Age-Specific Reference Ranges for PSA
Age and Race Specific PSA
Serum PSA (ng/ml)
PSA Density is determined by dividing the PSA by the
volume of the prostate (measured by the TRUS). The
larger a man’s prostate is the more likely he is to have a
higher PSA reading.
Age
(yr)
40-49
50-59
60-69
70-79
PSA Velocity is defined as the monitoring of the rate of
change of a PSA over time. At least three measurements
over a period 18 months are needed.
Whites
Japanese
African American
0-2.5
0-3.5
0-4.5
0-6.5
0-2.0
0-3.0
0-4.0
0-5.0
0-2.0
0-4.0
0-4.5
0-5.5
Why the controversy?
Reduction of Prostate Cancer mortality has not been
proven at a level of certainty. No randomized trials have
been completed although two are underway.
Urine Spectrum
Urology Nurses of Canada Review Board has
recently endorsed The Urine Spectrum, a color chart
developed by Jill Jeffery and Joyce Slater from
Victoria, BC.
The Prostate, Lung, Colon, and Ovary Cancer Screening
Trial (PLCO) and the European Randomized Study of
Screening for Prostate Cancer (ERSPC) both started in
1993. Data may be available by 2008.
This chart was developed to provide visual reference
and create consistent language when referring to
urine color in any care setting. There is also a
continuous bladder irrigation(CBI) troubleshooting
chart with Suggested Nursing Actions according to
urine color. They are marketed in kits that come with
color strips and a chart with the colors and
corresponding interventions.
The screening procedure of PSA testing and test intervals
are uncertain.
Over-diagnosis in screening is a significant issue and
how to distinguish the indolent versus the aggressive is
still a major question.
The Canadian Urological Association suggests that
patients be made aware of the early detection of Prostate
Cancer afforded by the use of PSA. There are no formal
suggestions as to when or how much.
In spite of all the debate, accumulating data indicates that
PSA testing is still the best test for early detection of
Prostate Cancer. PSA screening appears to be doing what
it’s supposed to be doing, finding tumors earlier.
Prof F. Schroder, 2005, New Developments in Screening
and Early Detection of Prostate Cancer
The standing ovation was saved for Irene LangeMechlan, the director of the Prostate Centre at
TSRCC. She touched everyone with her very
personal story of how she became the sole palliative
caregiver when her husband was diagnosed with
prostate cancer. She strongly recommended that men
should talk about their diagnosis and seek the
needed support from family and friends.
The conference was not only about listening to
medical experts. Two concurrent workshops
facilitated by Ron Benson and Jim Moran of the
Man to Man Prostate Cancer Support group were
held. These involved group discussions covering
topics which benefit all support groups.
Dr Chodak from Chicago gave a general overview of
all known treatment options and emphasized the
importance of patients getting involved in their own
care.
He was followed by Dr Toguri who gave a talk about
BPH and Drs Cook and Morgan, who covered all
aspects of Brachytherapy. Dr Finelli gave a
presentation on Laprascopic Radical Prostatectomy
and had the delegates fascinated with a video of the
surgical procedure. A new treatment called HIFU High Intensity Focused Ultrasound - was discussed
by Dr Woods.
Calgary will host the 2006 CPCN Conference and
UNC will continue to send representatives. We
encourage UNC chapters to assist support groups in
their areas.
Corporate Sponsors
IMPORTANT NOTICE
Urology Nurses of Canada
Corporate Sponsors for 2005/2006
The UNC has experienced an error with membership
this past year.
The colors are very accurate and there should be no
trouble having the interventions approved by Nursing
Practice Committees and Urology Departments. The
cost is very reasonable.
Each year Urology Nurses of Canada
acknowledges and thanks our national
Corporate Sponsors for their continued support.
One nurse states "I have had nurses from other floors
asking where they can get the color strips".
For the year 2005/2006 they are:
For further information please contact
Jill Jeffery - e-mail: [email protected]
Sources
In August a representative from UNC attended the
second CPCN conference held in Toronto. She was
in awe of the support and enthusiasm displayed by
both presenters and delegates. Once again about 150
men, some accompanied by their spouses, gathered
from across the country to learn more about Prostate
Cancer and the treatments available. They were also
there to share their experiences and the value of the
support groups they are involved with.
It has come to our attention that some new members
have not been receiving the Urologic Nursing journal
or the Pipeline.
If you had sent your membership in for the year 2005
and have not received your journals please contact
Susan Freed at [email protected]
Please remember that the new membership year is
from December to December.
Titanium Level
AstraZeneca
We apologise for any inconvenience. Our members
are very important to us.
Silver Level
Pfizer
Drs R. Gallagher/ M. Gleave, 2000, What is the Value
of PSA Screening in Prostate Cancer
Page 2
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The Prostate
“Rise to the Occasion: Overflow to the East” UEC - 2005
Dr. Allan Arneil
Halifax was the location of the Urological Excellence
Conference for 2005.
About 150 delegates from across the country converged
on the Maritimes for our annual UNC conference entitled
"Rise to the Occasion: Overflow to the East".
Following the warm welcomes by Dr Norman, Chief of
Urology Department and Susan Freed, UNC President,
Dr Bell discussed Prostate Cancer surgery and its
complications. He stated that our goals should be cancer
control, bladder control and sexual control.
The concurrent sessions were all very good and I found it
hard to choose.
The keynote address that sparked the most interest was
"Sexuality and the Teen". Nova Scotia’s new youth
sexual health resource, "Sex? – A Healthy Sexuality
Resource" is the product of a three year-long
development process
Nova Scotia has a wonderful Cancer Patient Navigator
service and nurses from this expanding program gave an
informative talk about this success story.
"Reaching for Gold with Neobladder Surgery – What
does nursing have to offer?" by Jean Brown an
Enterostomal Therapist gave many useful nursing tips.
Involving focus group work with over 500 youth,
parent/teacher focus groups and input from national and
provincial experts in the field of sexual health/sex
education. The speakers reviewed the resource, gave
opportunity for questions and each delegate was given a
copy.
Frankie Bates discussed the taboo topic of Stress Urinary
Incontinence and the need for advocacy groups to
improve the lives of women with SIU.
Dr Dianne Heritz gave a comprehensive presentation on
Interstitial Cystitis discussing prevalence, genetics,
etiology, diagnosis, treatments and management
strategies.
Once again hard work on the part of the organizing
committee paid off. They are to be thanked and
commended for their efforts. We still have the Urology
Song pinned on our notice board at work to remind us of
our travels and the urology nurses of Nova Scotia.
What I'd really like to know
Is why my prostate has to grow?
When I was young it had its day
But now these days have passed away
I thank my surgeon and the rest
A team I know will do their best
I hope my verse will raise a smile
And ease your efforts for a while
Annoying things I must endure
And sad to say they're hard to cure
I swallowed pills, and herbals too
Yet good results were all too few
The doctor took some blood from me
A PSA it was to be
If reading high there is a care
The cancer might be hiding there
It's like a door that shuts up tight
With symptoms always worse at night
As best I can I push and strain
In hopes the flow will start again
It was not high, it was not low
In between, I'd have to know
Higher than it was last year
A warning sign I guess I fear
Sometimes the bladder will not go
And other times it's very slow
And then at times it leaks away
Just why or when I cannot say
What we shall do is sit and wait
And test again at later date
If it is down then that is great
But if it's up what then's my fate?
I must be sure a toilet's near
When running water I can hear
Because the fact is surely true
That soon I will be "running" too
The tinkling sound as well I know
Will make my bladder want to flow
A surgeon's knife, spare me the thought
It maybe cure - or maybe not
Already I have lost some bits
Resulting in great benefits
Female drugs will slow things down
But bigger breasts could make me frown
What size bra should I obtain
To keep my bosoms free from strain?
Of all the drugs, I've run the race
And now a surgeon's knife I face
Although in truth I must admit
The knife is not attacking it
Radiation too can cure
Or will it? I'm not too sure
I know it makes one bald and sick
But maybe it would do the trick
In fact it is a tender spot
A private part the surgeon's got
I'd rather it was left alone
My reproductive hidden zone
Left alone they're often slow
These cancer cells to live and grow
There's quite a chance they would not kill
Ere death ensues from other ill
It does not fill my soul with glee
To have a tube stuck into me.
Though I'm assured it soon will go
Indeed I hope that that is so!
Page 6
No doubt you think I'm being morose
But what's to come no person knows
I trust my prostate is benign
And I will live on till ninety-nine
Page 3
UNC Info
Urology Nurses of Canada
The Urology Nurses of Canada
extends an invitation to all nurses and
allied health interested in urologic
nursing to join the association.
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is to enhance the specialty of urologic
nursing in Canada by promoting
education, research and clinical
practice.
The activities of the Urology Nurses
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development.
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each fall and convenes for an
educational meeting at the Canadian
Urological Association annual
meeting
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Membership in the UNC now entitles
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UNC Representatives 2005 - 2006
UNC Executive
The Urology Nurses of Canada is managed by an executive board composed of:
President: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Freed
Past President: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sue Hammond
Vice-President West: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Colleen Toothill
Vice-President East: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Emmi Champion
Vice-President Central: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fran Stewart
Membership: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Gina Porter
Sponsorship: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sandra Rowan
Treasurer: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lisa Lynch
Secretary: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Brenda Bonde
UNC Provincial Representatives
British Columbia: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jill Jeffery
Alberta: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Laurel McDonough
Sasketchewan: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Judy Pare
Manitoba: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Betty Kirk
Ontario: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Nancy Bauer
Ontario: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sylvia Robb
Quebec: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Raquel de Leon
Quebec: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Carol-Anne Lee
New Brunswick: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nancy Carson
Nova Scotia: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Liette Connor
Newfoundland and Labrador: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sue Walsh
Urology Nurses of
Canada Awards
The winners of the UNC Awards Program were
announced at the Urological Excellence Conference 2005 which was held in Halifax, NS during October.
These awards are made available through unrestricted
educational grants given via our Corporate Sponsorship
Program.
At each Urological Excellence Conference awards are
given by Urology Nurses of Canada for the best short
paper presentation and the best poster.
The winners of the award for best Short Paper
Presentation was Lorna Butler/Sue Marsh from Halifax,
NS reporting on research to develop a questionnaire for
accurate measurement of men’s sexual health. These men
have had prostate cancer and it is hoped that the
questionnaire will be used in future clinical trials.
The winner of the Male Sexual Dysfunction Award was
Getty Vasista from Halifax, NS. The corporate sponsor
was Pfizer.
The winners of the Poster award were Anne Crowell and
Susan Whalen from Halifax.
The winner of the Editorial Award was Louise
McIntosh from Gloucester, ON for her article entitled
"The Role of the Nurse in the Use of Vaginal Pessaries
To Treat Pelvic Organ Prolapse and/or Urinary
Incontinence: A Literature Review". It was published in
Urologic Nursing – February, 2005 The corporate
sponsor was AstraZeneca.
The title of their poster was "Education and
Documentation of Self catheterization in the Ambulatory
Setting for Women Undergoing Tension Free Vaginal Tape
Procedure".
We congratulate the winners.
Descriptions of each position are available in the UNC Constitution. Information on UNC news, programs
and reports can be located at www.unc.org
Local Chapter News info: www.unc.org
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Sandra Rowan
Liz Smits
Colleen Toothill
Sylvia Robb
Susan Freed
Carol-Ann Lee
Emmi Champion
Gina Porter
Sue Hammond
Tel:
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How to form a local UNC Group
For more information about
UNC, contact: Gina Porter,
Membership Coordinator at
[email protected]
or visit www.unc.org.
Corporate Sponsor
Award Winners
1. Contact nurses and allied health in your area interested in Urologic Nursing.
2. Pick a topic and a speaker (for the initial meeting).
3. Book meeting room.
4. Contact local sales rep for potential support of meeting.
5. Advertise meeting and distribute information about the UNC.
6. Create local executive e.g. chairperson, secretary, treasurer.
7. Organize educational meetings/events.
8. Contact UNC provincial representative regarding local business meetings.
9. Encourage submissions of articles and upcoming events to "Pipeline".
Help Wanted!
UNC Award of Merit
Every year Urology Nurses of Canada seeks nominations
for the Award of Merit. This is an award, which honors a
nurse who has not only
contributed to Urology Nurses of
Canada but has shown leadership
to her local colleagues and
demonstrated a high level of
nursing skills.
Awards, Awards
Is there some research in the field of urological
nursing you wish to do?
This year's winner is Emmi
Champion from Halifax, NS
What about developing some educational material?
Emmi was the Provincial Rep for
Nova Scotia for a year and has been Vice-President East
since 2000. She has chaired the hosting committee of
UEC-2005 and been very involved in the Halifax UNC
Chapter since 1995. She has spoken at past Urological
Excellence Conferences. Emmi works in the Urodynamics
Clinic at the Halifax Infirmary Emmi is a certified Nurse
Continence Advisor.
Is there some further education you wish to pursue?
Start thinking about applying for next year's awards.
The awards are Research, Editorial, Male Sexual
Dysfunction and Scholarship.
The UNC invites you to participate with some of the UNC initiatives including:
• Authors for Pipeline articles
• Submission of Abstracts for UEC-2006 Concurrent/Scientific Papers/Posters
Page 4
Congratulations Emmi!
Page 5
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