Prostate Cancer Early Detection V1.2020

Question 1

What race has a higher incidence of prostate ca?

Answer 1

African American

Question 2

For the race at highest risk, what is the age that you will consider to begin PSA screening?

Answer 2

40 years old

Question 3

What are the high-risk germline mutations?

Answer 3

BRCA1

BRCA2

Question 4

Between BRCA1 and BRCA2, which germline mutation may mean that prostate cancer will occur earlier? Which is more associated to prostate cancer mortality?

Answer 4

BRCA 2

BRCA 2

Question 5

Why is 5 alpha reductase use significant in the history of patients undergoing PCA early detection?

Answer 5

Because five alpha reductase inhibitors decrease PSA by 50% in 6 months use

Question 6

If the patient agrees to undergo prostate cancer early detection, what are the TWO MOST IMPORTANT BASELINE EXAMINATIONS that you will perform?

Answer 6

PSA

DRE

Question 7

Is PSA recommended to be used as a stand alone test in prostate cancer early detection?

Answer 7

No

Question 8

If DRE is suspicious for cancer, what is the next step that you will recommend?

Answer 8

Referral for Biopsy

Question 9

The first age bracket for prostate cancer early detection are men from 45-75 years old, what are the two subgroups of patients wherein you will consider lowering the age cut off to 40 years old?

Answer 9

African Americans

and those with BRCA1/BRCA2 mutations

Question 10

When do you test in men after 75 years of age?

Answer 10

Healthy
No co morbids

Tapos may rising PSA or have never undergone PSA testing

Question 11

In 45-75 y/o men, with normal DRE, and PSA <1 ng/mL, what is the recommendation?

Answer 11

PSA and DRE testing 2-4 year intervals

Question 12

In 45-75 y/o men, with normal DRE, and PSA of 1-3 ng/mL, what is the recommendation?

Answer 12

PSA and DRE testing 1-2 year intervals

Question 13

In 45-75 y/o men, with suspicious DRE, and/or PSA of >3 ng/mL, what is the recommendation?

Answer 13

Refer for evaluation for prostate biopsy

Question 14

Median PSA values for men aged 40-49?

Answer 14

0.5 to 0.7 ng/mL

Question 15

The following have a LOW RISK of having prostate cancer metastasis.

Men 60 and above with PSA:
Men >75 with PSA:

Answer 15

60 and above: PSA <1.0

75 and above: PSA <3.0

Question 16

In men >75 y/o, PSA of <4 ng/mL and NORMAL DRE, what is the next step?

Answer 16

Repeat testing at 1-4 years interval

Question 17

In men >75 y/o, PSA of 4 and above or very suspicious DRE, what is the next step?

Answer 17

Refer for evaluation for prostate biopsy

Question 18

PCPT, 15% of men have cancer at what PSA level?

Answer 18

4.0 ng/mL or less

Question 19

PCPT, 30-35% of men have cancer at what PSA level?

Answer 19

> 4-10 ng/mL

Question 20

PCPT, 67% of men have cancer at what PSA level?

Answer 20

> 10 ng/mL

Question 21

The 3 steps initiated when a patient is subjected for further evaluation for biopsy?

Answer 21

1. Repeat PSA
2. DRE if not yet done
3. Workup for benign disease

Question 22

What will you consider doing to improve SPECIFICITY of screening?

Answer 22

Biomarkers

and mpMPRI

Question 23

Free PSA when increased is associated with ____ risk of cancer?

Answer 23

LOWER

inverse relationship

Question 24

Bound PSA when increased is associated with ____ risk of cancer?

Answer 24

HIGHER

linear relationship

Question 25

PCA score is potentially informative after a ______ biopsy.

Answer 25

Negative

Question 26

One may consider doing multiparametric MRI prior to biopsy, but this more significantly increases the detection of significant _____-risk disease while lowering the detection of _____-risk disease.

Answer 26

HIGH LOW

Question 27

Does a negative MRI exclude the possibility of a cancer? | In the setting of a negative MRI, what are the two tests that you will request?

Answer 27

No Biomarkers and PSADensity

Question 28

Two routes of prostate biopsy.

Answer 28

Transrectal | Transperineal

Question 29

If biopsy is not elected, what is the recommended follow up?

Answer 29

Follow up in 6-12 months with PSA and DRE

Question 30

If cancer is seen, you will proceed to follow which guideline?

Answer 30

NCCN Prostate Cancer Guidelines Because that is what good doctors do, read the guidelines and not be archaic.

Question 31

If intraductal carcinoma (IDC) WITHOUT invasive carcinoma is seen, what is recommended in the NCCN guidelines for prostate cancer?

Answer 31

Molecular/Biomarker testing

Question 32

If intraductal carcinoma WITHOUT invasive carcinoma is seen, what are the TWO ancillaries that you will use when you repeat the biopsy?

Answer 32

Repeat biopsy with: 1. MRI targeting 2. Systematic biopsy

Question 33

If atypical intraductal proliferation (AIP) without invasive carcinoma is seen, what are the TWO ancillaries that you will use when you repeat the biopsy?

Answer 33

Repeat biopsy: 1. MRI targeting 2. Systematic biopsy

Question 34

When you see atypia that is suspicious for cancer, what will you consider requesting to improve the specificity of screening?

Answer 34

Consider BIOMARKERS that improve the specificity of screening and/or MULTIPARAMETRIC MRI.

Question 35

When you see atypia that is suspicious for cancer, what imaging can you request for further evaluation?

Answer 35

mpMRI

Question 36

When you see atypia that is suspicious for cancer, can you repeat the biopsy? In what manner?

Answer 36

Yes, repeat the biopsy with RELATIVE INCREASED SAMPLING OF THE ATYPICAL SITE.

Question 37

When you find MULTIFOCAL high-grade prostatic intraepithelial neoplasia (PIN) in the specimen, what are the 3 next steps?

Answer 37

1. Biomarkers 2. mpMRI 3. repeat the biopsy with RELATIVE INCREASED SAMPLING OF THE ATYPICAL SITE.

Question 38

When you find focal high-grade prostatic intraepithelial neoplasia (PIN) in the specimen, what is the recommended follow up?

Answer 38

1. PSA& DRE at 6-24 months interval | 2. Biomarkers, mpMRI, refined prostate biopsy techniques

Question 39

When you find focal high-grade prostatic intraepithelial neoplasia (PIN) in the specimen, how will you increase the specificity of screening?

Answer 39

Consider BIOMARKERS that improve the specificity of screening and/or MULTIPARAMETRIC MRI.

Question 40

Is repeating biopsy for benign results recommended?

Answer 40

Yes

Question 41

What are the tests that improve specificity in the post biopsy setting?

Answer 41

``` Biomarkers: Free PSA Prostate Health Index (PHI) SelectMDX 4Kscore ExoDx Prostate Test PCA3 ```

Question 42

Two age groups with PSA levels that will tell you to discontinue PSA testing.

Answer 42

>60 years old PSA of <1 >75 years old PSA of <3

Question 43

PSA velocity is the rate of change in PSA over time determined by at least how many separate PSA values calculated over how long?

Answer 43

3 separate values | 18 months

Question 44

The NCCN panel agrees that PSA velocity is useful in low or high PSAs?

Answer 44

LOW PSA

Question 45

What is the cut off of PSAV in ng/mL/year to make you decide whether to perform biopsy for men with decreased PSA levels or not?

Answer 45

0.35 ng/mL/year or more

Question 46

60-90% circulating PSA is bound or unbound?

Answer 46

Bound

Question 47

What is the protease inhibitor where PSA is mostly bound?

Answer 47

Alpha-1-antichymotrypsin

Question 48

How many percent fPSA is the cutoff to detect 95% of prostate cancers and avoid 20% unnecessary prostate biopsies?

Answer 48

25%

Question 49

How do you compute for PSA density? | PSAD discriminates prostate cancer from what disease entity?

Answer 49

PSA divided by prostate volume BPH

Question 50

PSAD cutoff?

Answer 50

0.15

Question 51

Noncoding, prostate tissue specific RNA that is overexpressed in prostate cancer?

Answer 51

PCA3

Question 52

Noncoding, prostate tissue specific RNA that is overexpressed in prostate cancer is detected in what specimen?

Answer 52

Urine

Question 53

Is PCA3 appropriate to use in the initial biopsy setting?

Answer 53

No

Question 54

What comprises the PHI test?

Answer 54

T-F-P total PSA free PSA pro PSA

Question 55

Cutoff score of the PHI test to avoid 36% of biopsies with approximately 2.5% of high grade cancers missed?

Answer 55

Score of 24

Question 56

PHI is recommended at what PSA levels?

Answer 56

4-10

Question 57

The 4K score test is a combination of what tests? Does it have an optimal threshold?

Answer 57

H-FIT free PSA total PSA intact PSA Human Kallikrein 2 Threshold of 15% or more.

Question 58

Can the 4K test be considered prior to biopsy? How about repeat biopsy?

Answer 58

Yes. They also can be considered in patients with a prior negative biopsy who are thought to be at higher risk for clinically significant prostate cancer.

Question 59

ConfirmMDx is a non-FDA approved test that can be used on repeat or initial biopsy?

Answer 59

NCCN panel: it can be considered as an option for men contemplating REPEAT BIOPSY The assay may identify individuals at higher risk of prostate cancer diagnosis on repeat biopsy.

Question 60

ExoDx Prostate score (EPI) detects which assays?

Answer 60

PCA3 ERG RNA used in initial or repeat biopsy

Question 61

Which confers a lower risk of sepsis – TRUS or transperineal biopsy?

Answer 61

Transperineal biopsy

Question 62

Most common drugs used for prophylaxis in TRUS biopsy?

Answer 62

Ciprofloxacin

Question 63

How long will you limit prophylaxis in TRUS biopsy?

Answer 63

No more than 24 hours