The JABLONSKI DEBATES

PSA TESTING Getting Prostrate for the Prostate

ASA Banff 2015

The JABLONSKI DEBATES

Learning has never been this much “fun”

(just like walking through a field littered with land mines….)

ASA Banff 2015

The JABLONSKI DEBATES

DISCLOSURES

ASA Banff 2015

Faculty/Presenter Disclosure• Faculty/Presenter: Ted Jablonski

Relationships with commercial interests:

– Grants/Research Support: Principal Investigator in clinical studies funded by Pfizer, Lilly

– Speakers Bureau/Honoraria: Abbott Laboratories, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Edelman, Eli Lilly, GlaxoSmithKline, Janssen-Ortho, Lundbeck, Merck Frosst, Novartis, Paladin Labs, Pfizer, Sanofi-Aventis, Schering, Shire, Solvay, Takeda, Valeant, Watson

– Consulting Fees: Not applicable

– Other: Not applicable

• Faculty/Presenter: Eric Jablonski

Relationships with commercial interests:

– Grants/Research Support: Not applicable

– Speakers Bureau/Honoraria: Not applicable

– Consulting Fees: Not applicable

– Other: Not applicable

CFPC COI Template -Slide 1

ACFP 60th ASADisclosure of Commercial Support This program has received financial support in the form of sponsorship

from: Alberta Medical Association RHS Canada/The Snore Centre Aspen Pharma Scotiabank Purdue Pharma VitalAire University of Calgary Health Quality Council of Alberta Alberta Health Services eReferral Janssen Eli Lilly

This program has received in-kind support from The Rimrock Resort Hotel in the form of a contribution to food/beverage at the Thursday Research Poster Presentations and Welcome Reception.

Potential for conflict(s) of interest:Those speakers/faculty who have made COI disclosure are noted in the 60th ASA Program and on the Salon A/B slide scroll.

CFPC COI Template -Slide 2

Mitigating Potential Bias• ACFP:

→ The ACFP’s Sponsorship Guidelines apply to ASA Sponsorship. The ACFP abides by the Canadian Medical Association’s Policy Guidelines for Physicians in Interactions With Industry and the Rx&D Association’s Rx&D Code of Ethical Practices. As a non-profit organization, the ACFP complies with Canada Revenue Agency regulations. When considering acceptance of sponsorship, the ACFP considers and accepts sponsorship only from those whose products, services, policies and values align with the ACFP vision, values, goals and strategies priorities.

• ASA Planning Committee: → Consideration was given by the 60th ASA Planning Committee to identify when an

speaker’s personal or professional interest may compete with or have actual, potential or apparent influence over their presentation.

→ Material/Learning Objectives and/or session description was developed and reviewed by a Planning Committee composed of experts/family physicians responsible for overseeing the program’s needs assessment and subsequent content development to ensure accuracy and fair balance.

→ The 60th ASA Planning Committee reviewed Sponsorship Agreements to identify any actual, potential or apparent influence over the program.

→ Information / recommendations in the program are evidence- and / or guidelines-based, and opinions of the independent speakers will be identified as such

CFPC COI Template -Slide 3

Clinical Assistant ProfessorUniversity of Calgary, Department of Family Medicine

Medical Lead, Calgary Foothills Primary Care Network

Family Physician and Partner, Crowfoot Village Family Practice, Calgary

Medical Director, Jablonski Sexual Health and Wellness & Clinical Associate, Men’s Sexual Health Clinic, Southern Alberta Institute of Urology, Rocky View Hospital, Calgary

Dr. Ted JablonskiBSc Med, MD, CCFP, FCFP

Graduate of University of Calgary

Clinical Assistant ProfessorUniversity of Calgary, Department of Family Medicine

Member of Calgary Rural Primary Care Network

Family Physician – Foothills Family Medical Centre in Black Diamond Family, AB

Dr. Eric JablonskiBSc, MD, CCFP

PSA TESTING Getting Prostrate for the Prostate

OBJECTIVES

ASA Banff 2015

ASA Banff 2015

OBJECTIVES- Review the basics of the prostate gland- Explain the science of PSA Testing- Explore PSA test for case finding /dx abnormalities - Review PSA Testing for prostate cancer screening- DEBATE the Pros & Cons of PSA Testing in 2015 and

provide a rational clinical guide to its potential use

PSA TESTING Getting Prostrate for the Prostate

PRE- NEEDS ASSESSMENT Polling the Audience

ASA Banff 2015

DO NO HARM!When all is said and done, we all want

to do what is RIGHT for our patients

…and the more I learn, the harder it gets

ASA Banff 2015

Tom W. Longstanding patient sent in by his wife to

get his prostate checked

55 year old healthy male, co-worker just diagnosed with metastatic prostate cancer

No known FH of prostate cancer, non-smoker, generally healthy lifestyle

Has urinary complaints with occasional frequency and urgency, nocturia 2 - 3 / night, no incontinence, rare episodes of hesitancy and poor stream

ASA Banff 2015

Tom W.

He states “I guess you’re going to have to give me a finger up the butt and a blood test – and just one finger please, I don’t need a second opinion just yet”

You roll your eyes and say….ASA Banff 2015

Tom W. 1. you’re right, so let’s get on it

2. EBM (Evidence based medicine) has clearly stated that you need neither a DRE, nor a PSA test, so relax….

3. I will perform a DRE but not a PSA test

4. You need a PSA test but not a DRE

5. Sorry, before we do anything – what are you concerned about ? and how much do your current symptoms bother you? ASA Banff 2015

Tom W.

“These symptoms are actually really bothering me a lot!”

“And of course I am worried that I could have prostate cancer, I’ve recently talked to Brett Wilson (my boss is well connected)” ASA Banff 2015

Tom W.

So what do you do say? What do you do?

THINK ABOUT THIS CASE as we go through presentation and hopefully the answer will become a bit clearer…… ASA Banff 2015

PROSTATE GLANDmano a mano

ASA Banff 2015

PROSTATE GLANDGLAND gone WILD

ASA Banff 2015

PROSTATE GLANDReining in the beast

ASA Banff 2015

PSA TESTWTF

ASA Banff 2015