Ask a Librarian: Movember – prostate cancer

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According to the Canadian Cancer Society, prostate cancer is the most common cancer to affect men in Canada. One in nine men will be diagnosed with the disease in their lifetime. Risk factors for prostate cancer are age (i.e. over 50, primarily 65+), a first degree relative with prostate cancer, African descent and being overweight. Screening increases the likelihood of prostate cancer being detected at an early stage―when there are more treatment options and the chance of survival is highest.

Here are some resources on prostate cancer selected by Joule’s Ask a Librarian team using a variety of tools included with CMA membership.

Clinical summary from DynaMed

Access DynaMed online or through the mobile app to get concise overviews and detailed recommendations, medical graphics and images, drug information from Micromedex and more.

Prostate Cancer Screening

Who and when to screen

Recent updates:

23 Aug 2019

Decision aids may not affect screening discussion rates or decision to undergo screening in men considering prostate cancer screening (JAMA Intern Med 2019 Jun 24 early online).

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23 Aug 2019

Decision aids may slightly increase knowledge and reduce decisional conflict in men considering prostate cancer screening (JAMA Intern Med 2019 Jun 24 early online).

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9 May 2019

Review of prostate cancer screening (Prim Care 2019 Jun).

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5 Apr 2019

PSA screening may slightly reduce prostate cancer mortality with no reduction of overall mortality over 16 years of follow-up (Eur Urol 2019 Feb 26 early online).

Preview (CMA members can access all summaries via this link)

Clinical summary from Essential Evidence Plus

Essential Evidence Plus is an evidence-based point of care tool with access to over 13,000 topics, guidelines, abstracts and summaries. For a synopsis of new evidence reviewed by the Essential Evidence Plus editorial team, subscribe to the POEMs daily newsletter.

Prostate cancer

  • Overall bottom line: Prostate cancer screening is inexact and in its current state provides a small cancer-specific mortality benefit (NNT ~800 over 13 years) and reduction in metastatic disease (3 per 1000 person-years), and no all-cause mortality benefit. There are significant harms including incontinence and sexual dysfunction for many treated men.
  • Patients and physicians should engage in shared decision making before undertaking screening, and if undertaken should be limited to healthy men age 55 to 69 who fully understand the potential harms and benefits. 
  • Initial therapy for localized disease can be radical prostatectomy, radiotherapy, or active surveillance, with the potential harms of treatment varying but all being similarly effective in terms of mortality.

Read more via Essential Evidence Plus (CMA members only)

 

Synopsis of clinical studies in POEMs by Essential Evidence Plus:

POEM: Prostatectomy reduces mortality compared with no surveillance in men with T2 cancer who presented with symptoms

Clinical question
In men with symptomatically detected prostate cancer, does radical prostatectomy reduce mortality compared with watchful waiting?

Bottom line
Although at first glance the results of this trial may appear to strengthen the argument in favor of prostate cancer screening using a prostate-specific antigen (PSA) test, it is important to clarify that this was not a screening study. Also, the patients had a much higher PSA result (mean 13 vs median 4.8 ng/mL) and stage (mostly T2 vs mostly T1c) than patients in the recent ProtecT trial. Also, the "watchful waiting" in this study was not the same as the contemporary practice of active surveillance. This study does tell us that for men presenting because of symptoms, who are diagnosed with stage T2 prostate cancer, and have a fairly high PSA level, surgery reduces mortality compared with doing nothing. 

Reference
Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer: 29-year follow-up. N Engl J Med 2018;379(24):2319-2329.

 

Further reading

Book Chapters via ClinicalKey (CMA members only):

ClinicalKey drives better care by delivering fast, concise answers, and deep access to evidence whenever, wherever you need it. ClinicalKey includes access to 1,000+ textbooks, 600 full-text journals, images, videos and customizable patient handouts across 30+ medical specialties

Articles via CMAJ:

Magnetic resonance imaging diagnosis of prostate cancer: promise and caution

Douglas C. Cheung and Antonio Finelli

CMAJ October 28, 2019 191 (43) E1177-E1178

Cancer: prostate – CMAJ Collection

 

Clinical Practice Guidelines via CPG Infobase:

CPG Infobase contains approximately 1,200 evidence-based Canadian clinical practice guidelines (CPGs) developed or endorsed by authoritative medical or health organizations in Canada.

Canadian Clinical practice guidelines on Prostate Cancer in the CPG Infobase.

 

Drug Information via CPS online and on the RxTx app (CMA members only):

CPS offers 2000+Canadian product monographs for drugs, vaccines and natural health products that are developed by manufacturers, approved by Health Canada and optimized by CPhA editors

Search “prostate cancer” in the CPS on the RxTx app to find related drug monographs that provide information regarding dosage, adverse effects, drug interactions and action and clinical pharmacology.

The CPS Online includes patient handouts. Search “prostate cancer” and select “Information for patients” to access handouts on a number of drugs for this indication.

 

Free information sources

Prostate cancer – Canadian Cancer Society

Prostate cancer treatment options – Prostate Cancer Canada

Early versus deferred standard androgen suppression therapy for advanced hormone‐sensitive prostate cancer – Cochrane Review 11 June 2019 Conclusions changed (summary only)

Recent trends in prostate cancer in Canada, Apr 2019 – Statistics Canada

 

Need more information or have a more focused clinical question on prostate cancer (or any other clinical topic of interest)? Contact the Ask a Librarian team to request a literature search.

About the author

Joule’s medical librarians are the professionals behind “Ask a Librarian”, a service for all CMA members looking for clinical search expertise. This experienced team of librarians can support you by searching on your behalf, teaching you effective search strategies or training you to use our clinical resources.

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