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Andrew NCCN 2020 > Prostate Cancer Early Detection V1.2020 > Flashcards

Prostate Cancer Early Detection V1.2020 Flashcards

1
Q

What race has a higher incidence of prostate ca?

A

African American

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2
Q

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

A

40 years old

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3
Q

What are the high-risk germline mutations?

A

BRCA1

BRCA2

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4
Q

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

A

BRCA 2

BRCA 2

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5
Q

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

A

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

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6
Q

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

A

PSA

DRE

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7
Q

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

A

No

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8
Q

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

A

Referral for Biopsy

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9
Q

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?

A

African Americans

and those with BRCA1/BRCA2 mutations

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10
Q

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

A

Healthy
No co morbids

Tapos may rising PSA or have never undergone PSA testing

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11
Q

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

A

PSA and DRE testing 2-4 year intervals

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12
Q

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

A

PSA and DRE testing 1-2 year intervals

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13
Q

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

A

Refer for evaluation for prostate biopsy

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14
Q

Median PSA values for men aged 40-49?

A

0.5 to 0.7 ng/mL

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15
Q

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

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

A

60 and above: PSA <1.0

75 and above: PSA <3.0

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16
Q

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

A

Repeat testing at 1-4 years interval

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17
Q

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

A

Refer for evaluation for prostate biopsy

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18
Q

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

A

4.0 ng/mL or less

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19
Q

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

A

> 4-10 ng/mL

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20
Q

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

A

> 10 ng/mL

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21
Q

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

A
  1. Repeat PSA
  2. DRE if not yet done
  3. Workup for benign disease
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22
Q

What will you consider doing to improve SPECIFICITY of screening?

A

Biomarkers

and mpMPRI

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23
Q

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

A

LOWER

inverse relationship

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24
Q

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

A

HIGHER

linear relationship

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25
Q

PCA score is potentially informative after a ______ biopsy.

A

Negative

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26
Q

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.

A

HIGH

LOW

27
Q

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?

A

No

Biomarkers and PSADensity

28
Q

Two routes of prostate biopsy.

A

Transrectal

Transperineal

29
Q

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

A

Follow up in 6-12 months with PSA and DRE

30
Q

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

A

NCCN Prostate Cancer Guidelines

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

31
Q

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

A

Molecular/Biomarker testing

32
Q

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

A

Repeat biopsy with:

  1. MRI targeting
  2. Systematic biopsy
33
Q

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

A

Repeat biopsy:

  1. MRI targeting
  2. Systematic biopsy
34
Q

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

A

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

35
Q

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

A

mpMRI

36
Q

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

A

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

37
Q

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

A
  1. Biomarkers
  2. mpMRI
  3. repeat the biopsy with RELATIVE INCREASED SAMPLING OF THE ATYPICAL SITE.
38
Q

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

A
  1. PSA& DRE at 6-24 months interval

2. Biomarkers, mpMRI, refined prostate biopsy techniques

39
Q

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

A

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

40
Q

Is repeating biopsy for benign results recommended?

A

Yes

41
Q

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

A 
Biomarkers:
Free PSA
Prostate Health Index (PHI)
SelectMDX
4Kscore
ExoDx Prostate Test
PCA3
42
Q

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

A

> 60 years old PSA of <1

> 75 years old PSA of <3

43
Q

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

A

3 separate values

18 months

44
Q

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

A

LOW PSA

45
Q

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?

A

0.35 ng/mL/year or more

46
Q

60-90% circulating PSA is bound or unbound?

A

Bound

47
Q

What is the protease inhibitor where PSA is mostly bound?

A

Alpha-1-antichymotrypsin

48
Q

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

A

25%

49
Q

How do you compute for PSA density?

PSAD discriminates prostate cancer from what disease entity?

A

PSA divided by prostate volume

BPH

50
Q

PSAD cutoff?

A

0.15

51
Q

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

A

PCA3

52
Q

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

A

Urine

53
Q

Is PCA3 appropriate to use in the initial biopsy setting?

A

No

54
Q

What comprises the PHI test?

A

T-F-P

total PSA
free PSA
pro PSA

55
Q

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

A

Score of 24

56
Q

PHI is recommended at what PSA levels?

A

4-10

57
Q

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

A

H-FIT

free PSA
total PSA
intact PSA
Human Kallikrein 2

Threshold of 15% or more.

58
Q

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

A

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.

59
Q

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

A

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.

60
Q

ExoDx Prostate score (EPI) detects which assays?

A

PCA3
ERG RNA

used in initial or repeat biopsy

61
Q

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

A

Transperineal biopsy

62
Q

Most common drugs used for prophylaxis in TRUS biopsy?

A

Ciprofloxacin

63
Q

How long will you limit prophylaxis in TRUS biopsy?

A

No more than 24 hours

Andrew NCCN 2020 (1 decks)

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