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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Optimizing Therapeutic Decision Making: PSA as a Biomarker for Benign Prostatic Hyperplasia Disease Progression


GOAL
The goal of this issue is to provide urologists and primary care physicians with the most current information available on Prostate Specific Antigen (PSA) as a biomarker for benign prostatic hyperplasia.

TARGET AUDIENCE
This activity is designed for urologists and primary care physicians. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Review the natural history and progression of benign prostatic hyperplasia (BPH).
  • Describe the correlates of BPH progression and identify the best way to measure it.
  • Discuss the relationship between serum prostate-specific antigen (PSA) and prostate volume in BPH.
  • Discuss the role of PSA and prostate volume in predicting the progression of BPH.
  • Identify the PSA cut-off value associated with high likelihood of BPH progression.
  • Understand the advantages and disadvantages of PSA as a biomarker in BPH.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 1 hour.

Release date: April 15, 2003. Expiration date: April 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from GlaxoSmithKline.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Alan W. Partin, MD, PhD
    Professor of Urologic Oncology
    Brady Urological Institute
    Johns Hopkins Medical Institutions
    Baltimore, Maryland
    • Dr Partin reports having no financial or advisory relationships with any corporate organization.

PARTICIPATING FACULTY

    Claus G. Roehrborn, MD
    Professor and Chairman
    Department of Urology
    University of Texas Southwestern Medical Center at Dallas
    Dallas, Texas
    • Dr Roehrborn reports receiving grants and research support from GlaxoSmithKline and Merck Sharp and Dohme.

    Michael M. Lieber, MD
    Professor of Urology
    Department of Urology
    Vice Chair for Research, Department of Urology
    Mayo Clinic and Mayo Foundation
    Rochester, Minnesota
    • Dr Lieber reports receiving grants and research support from Abbott Laboratories, GlaxoSmithKline, Merck & Co, Vysis Inc, and receiving honoraria and serving as a consultant to GlaxoSmithKline and Merck & Co.

    Leonard S. Marks, MD
    Associate Professor
    Department of Surgery/Oncology
    UCLA School of Medicine
    Founding Medical Director Urological Sciences Research Foundation
    Culver City, California
    • Dr Marks reports receiving honoraria and serving as a consultant to GlaxoSmithKline, Merck & Co, and Sanofi-Synthelabo.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Serum Prostate-Specific Antigen as a Biomarker for Benign Prostatic Hyperplasia Disease Progression
Alan W. Partin, MD, PhD*

Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are nearly universal among men reaching normal life expectancy and are common reasons for men to seek healthcare. Research has shown that, in some men, BPH is characterized by progressive increases in prostate volume, worsening of LUTS, deterioration in urinary flow rate, and increases in risk of acute urinary retention or surgery. However, progression of BPH does not occur to the same extent or at the same rate in all men. Recent advances in understanding of the prostate have shed light on the relationships among urinary tract signs and symptoms and disease progression. In particular, research shows that serum levels of prostate-specific antigen (PSA), a commonly used screening test for prostate cancer, are also useful in predicting disease progression in patients with BPH.

In February 2003, Johns Hopkins Advanced Studies in Medicine convened in Baltimore a panel of experts to review the data on PSA as a biomarker for disease progression in BPH and to formulate recommendations useful for managing patients with BPH and/or LUTS in clinical practice. The monograph in this issue describes the proceedings of the Baltimore meeting.

The panel concluded that PSA can be useful in predicting disease progression in BPH when considered in conjunction with other clinical indicators. Specifically, patients with PSA of at least 1.5 ng/mL, in the presence of an enlarged prostate and LUTS, are at increased risk of disease progression. These patients may benefit from close monitoring and may be good candidates for pharmacotherapy to arrest the disease process. On the other hand, patients with a small prostate gland, low serum PSA, and bothersome LUTS might benefit most from symptomatic treatment but should be periodically monitored to assess changes in clinical status. The strong predictive utility of PSA—combined with the fact that it, unlike other clinical markers of BPH status, can be accurately and easily measured—renders it an important tool for the clinician seeking to optimize outcomes for patients with BPH. The panel hopes that the information provided by this program will be useful in therapeutic decision making and will help to improve the quality of care for patients with LUTS and BPH.

*Professor of Urologic Oncology, Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.