Urology Flashcards
(22 cards)
Prostate cancer testing is appropriate for males WITH a family history aged
40-70+
Prostate cancer testing is appropriate for males WITHOUT a family history aged
50-70
What are the 3 highest causes of cancer deaths for males in NZ?
- Lung
- Colorectal
- Prostate
Risk of prostate cancer increases or decreases with age?
increases
in 40s 1/500
in 50s 1/50
in 70s 1/9
BUT 50-60% of males >79 will die WITH ASYMPTOMATIC prostate cancer
If a patient has an isolated raised PSA but is ASYMPTOMATIC with a NORMAL DRE and NO red flags, what is the next step?
Repeat PSA in 6-12 weeks
True or false - the higher the PSA, the higher the chance of prostate cancer
True
4–10 = 40% chance of cancer on prostate biopsy
>10 = 67% chance of cancer; values above this level are rarely caused by benign prostatic enlargement or hyperplasia
>20 = high likelihood of cancer; prostatitis is an alternative cause
When is routine referral 6-8 weeks appropriate?
Asymptomatic patients with normal DRE and 2 PSAs as below:
Aged 50–70 years and 2 PSA tests ≥ 4.0
Aged 71–75 years and 2 PSA tests are ≥ 10.0 micrograms/L
Aged 76+ years and 2 PSA tests are ≥ 20
OR
ABNORMAL DRE with normal PSA
OR
Consider if below threshold BUT rising significantly from earlier low levels in previous years, e.g. an increase of 0.75 micrograms/L per year over two consecutive years
What is the PSA referral threshold for 50-70 year old asymptomatic patients with normal DRE
2x results ≥ 4.0
What is the PSA referral threshold for 71-75 year old asymptomatic patients with normal DRE
2x results ≥ 10
What is the PSA referral threshold for 76+ year old asymptomatic patients with normal DRE
2x results ≥ 20
When should you retest an asymptomatic patient with NORMAL PSA and NORMAL DRE and NO family history?
1-4 yearly.
“Further testing may not be necessary, but could be offered at two to four year intervals until the age of 70 years if the patient wishes. however some experts advise repeat testing at one to two year intervals e.g. in a younger man with a PSA at the higher end of the normal range”
When should you retest an asymptomatic patient with NORMAL PSA and NORMAL DRE, WITH a family history?
Annual testing aged 40-70
When might ongoing PSA testing >70years be appropriate?
- Family history of prostate cancer
- Previously elevated PSA levels
–> IF they have a life expectancy of 10+ years
Prostate cancer symptoms
Nocturia
Reduced flow
Delay in initiating flow
Urinary frequency
Feeling of full bladder / incomplete emptying
Dysuria
Haematuria
Erectile dysfunction
Red flags suggestive of metastatic disease
Bone pain
Macroscopic haematuria
Spinal cord compression
Renal failure
What is the urgency of referral for a symptomatic patient with a single PSA level ≥10 micrograms/L with severe back pain and symptoms consistent with cauda equina or spinal cord compression
Acute (24h)
What is the urgency of referral for a symptomatic patient with a single PSA level ≥10 and one of:
Renal failure
New onset, progressive and severe bone pain
Macroscopic haematuria
A hard or irregular prostate on DRE
Urgent (14 days)
PSA >10 and irregular prostate
PSA levels which are abnormal on two measures 6–12 weeks apart:
≥4.0 micrograms/L for males aged 50–70 years
≥10.0 micrograms/L for males aged 71–75 years
≥20 micrograms/L for males aged ≥76 years
Routine referral
When is watchful waiting appropriate in a diagnosis of prostate cancer?
typically reserved for patients with a life expectancy of under ten years, where the aim is to monitor for development of symptoms or disease progression based on PSA levels and DRE results
Focus on QOL
When is active surveillance appropriate and what does it involve?
Life expectancy over 10 years and with low risk disease.
Aims to reduce the burden of adverse effects related to treatment by monitoring the cancer with a regular predefined surveillance protocol and only undergoing curative treatment if the cancer progresses.
Active surveillance includes repeat PSA tests, DRE, prostate biopsies and possibly MRI scans to ensure curative treatment is initiated when there is evidence of disease progression.
If patients are undergoing active surveillance:6
Clearly identify this on practice records
Set recalls and reminders for monitoring as per their management plan
Communicate information about the management plan to any other relevant healthcare providers, e.g. if the patient moves practices
What is the appropriate follow up for a patient who has undergone prostate cancer treatment (radical prostatectomy, chemo or radiation)
As per oncologist/urologist but generally
PSA tests every 6 monthly for 2 years
Then annually thereafter
Prostate Cancer screening spiel
We know that prostate cancer becomes more common as men age. It is a personal choice. Screening involves 2 parts- a blood test “PSA” and a digital rectal exam, both parts are important. Sometimes we end up with false positives. Many men who have a high blood test / high PSA will NOT have prostate cancer but will still need to undergo. Recommended if family history. Kupe website.
