Prostate Investigations and Diagnosis Flashcards
(31 cards)
What is PSA?
Prostate specific antigen is a protein produced by normal and malignant prostate cells
What is PSA secreted by?
Secreted by the epithelial cells within the prostate into the prostatic fluid, allowing sperm to move more freely
How does PSA indicate prostate cancer?
When cancer arises in the prostate, the changes to the structure of the gland allows more PSA to leak out into the blood, resulting in a higher circulating PSA
What are some of the reasons linked to a high PSA?
Urinary tract infection (weeks later)
Recent ejaculation/stimulation of the gland or anal sex (last 48 hours)
Vigorous exercise such as cycling (last 48 hours)
Medications
DRE before PSA
Prostate biopsy (last 6 weeks)
Enlarged prostate
What is benign prostate hyperplasia?
Increase in the number of cells
What is benign prostate enlargement?
Increase in the size of the gland
Can both BPH and BPE affect urination?
Yes, they both can due to the pressure on the urethra
What does TURP stand for?
Transurethral Resection of the Prostate
Advantages of PSA testing?
Early detection - earlier stage
Treatment options available
Disadvantages of PSA testing?
False negatives > 15%may have prostate cancer, 2%have high-grade cancer
False positives > 75% negative biopsy
Unnecessary investigations > Biopsy – invasive, infection risk
Unnecessary treatment?
Cancer may never become clinically evident/cause morbidity.
Treatment = side effects
Stress/anxiety
How will the prostate feel in DRE?
Normal, enlarged (BPE/BPH, Prostatitis) or hard/lumpy (Indicative of possible cancer)
Limitations of DRE?
There is a posterior aspect of the prostate - what if the tumour is somewhere it cannot be felt?
When should a GP urgently refer (2-week pathway) a patient?
Abnormal DRE AND high/rising PSA
What is the first-line investigation for people with suspected clinically localised prostate cancer?
Multiparametric MRI
Would palliative patients be offered mpMRI?
No, only patients who are able to radical treatment
What should patient be offered if mpMRI Likert score is 3 or more?
Multiparametic MRI-influenced prostate biopsy
What should a patient be offered if mpMRI Likert score is 1 or 2?
Consider omitting a prostate biopsy but only after discussing risks and benefits. If patient opts to have biopsy, offer systematic prostate biopsy (Transrectal ultrasound-guided biopsy or transperineal biopsy following mpMRI but needle placement not influenced by scan information
What happens in a transrectal ultrasound-guided biopsy (TRUS)?
Ultrasound probe inserted into rectum
Local anaesthetic to numb the area
Needle placed alongside the probe and inserted through the rectal wall into the prostate
10-12 samples taken
Advantages of TRUS?
Detects prostate cancer - If aggressive (fast growing) cancer is detected at an earlier stage, treatment may prevent spread
Disadvantages of TRUS?
Biopsies find <50% of cancer MRI misses
1 in 100 people develop sepsis after TRUS
What happens in a transperineal prostate biopsy?
Ultrasound probe inserted into rectum
Needle inserted through perineum (skin between the scrotum and anus)
Template biopsy: general anaesthetic, grid placed over skin and 2-3 cores sampled from 8 sites
Local Anaesthetic Transperineal Biopsy (LATP): Grid or freehand
Advantages of transperineal prostate biopsy?
Risk of sepsis greatly reduced
Easier access to anterior and apex of the prostate - may improve detection
If Likert score is 3 or more and biopsy is negative what happens?
Discussed at MDT to consider repeat biopsy
For men with a raised PSA, mpMRI Likert 1-2 (or contraindication to MRI) and negative biopsy what happens?
Repeat PSA test 3-6 months and offer repeat biopsy if suspicion of cancer is high. If low, discharge to primary care and repeat PSA testing every 2 years
