1 / 20

The PSA Test

The PSA Test . Graeme Gatherer 25.11.03. Prostate Cancer:background facts. 2 nd most common cause of cancer related deaths in men In UK- 20,000 Dx annually, 9500 die Rare below 50. Median age 75 Increased risk with +ve FH, African, African/Carribean

MartaAdara
Télécharger la présentation

The PSA Test

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The PSA Test Graeme Gatherer 25.11.03

  2. Prostate Cancer:background facts • 2nd most common cause of cancer related deaths in men • In UK- 20,000 Dx annually, 9500 die • Rare below 50. Median age 75 • Increased risk with +ve FH, African, African/Carribean • Range of tumours- slow growing to very aggressive • Men are more likely to die with prostate cancer than of it

  3. Patient Mr A.N • 60yrs • Initial presentation- frequency,dysuria,fever • Urine- E.coli, Rx Cephalexin, fluids • 4 weeks later, c/o nocturia x 2, occas.hesitancy, occas.urgency, frequency, term.dribbling, no haematuria • “slight inconvenience”, otherwise well • pr ?mildly enlarged prostate

  4. Mr A.N continued • ? BPH • Do PSA, U+Es, r/v with results • ? Consider alpha blocker • Do International Prostate Symptom Score

  5. Mr A.N continued • PSA 9.5 (0-4) • D/W Colleague, suggested repeat in a month or so • Noticed in another patients notes that other GP had referred to urology a patient with a PSA of 5. • Prompted me to do some reading

  6. Detecting Prostate Cancers • Prostate specific antigen(PSA) test • Digital rectal examination • Transrectal ultrasound guided prostate biopsy

  7. The PSA Test • Currently the best method of identifying localised cancer • Also found in men without prostate cancer • Rises with age

  8. Test Limitations • Not diagnostic • Is tissue specific but not tumour specific- Thus- benign enlargement, prostatits, lower UTIs can cause elevated PSA About 2/3 of men with an elevated PSA do not have prostate cancer detectable at biopsy

  9. Test Limitations • Up to 20% of all men with clinically significant prostate cancer will have a normal PSA • Test will lead to the identification of cancers which would not have become clinically evident in the man’s lifetime • Test will not distinguish between aggressive tumours/non aggressive

  10. Test Limitations • All men should know they are having a PSA Test and be informed of the implications • Opportunistic testing is not recommended

  11. PSA Test Practicalities • Before having a PSA test men should NOT have: • an active urinary infection • ejaculated in the previous 48 hrs • exercised vigorously in the previous 48hrs • Had a prostate biopsy in the previous 6 weeks • if practical, do before digital rectal examination (if not- delay for 1 week after DRE)

  12. Referral guidance • Prostate Cancer Risk Management Programme, as interim guidance recommends the following cut-off values are used for the PSA test Age(years) PSA cut-off 50-59 3 and above 60-69 4 and above 70 and over 5 and above Whereas a very high PSA is strongly suggestive of cancer it is less clear when mildly elevated

  13. Digital Rectal Examination • DRE is a useful diagnostic test for men with symptoms- it allows assessment of the prostate, although many early cancers will not be detected • DRE is not recommended as a screening test in asymptomatic men

  14. Transrectal ultrasound guided prostate biopsy • Uncomfortable/painful • Significant anxiety • 20% tumours get “missed” • Prolonged follow-up and anxiety for men with neg. Bx but pesistently high PSAs • Risks of infection/haematuria/haematospermia • 2/3 men undergoing TRUS are not found to have cancer

  15. Treatments for prostate cancer • The management of localised cancer is central to the controversy surrounding screening • Lack of evidence- ?reduction in mortality ?which treatment option Active treatments have significant S/Es

  16. Treatment Options • Active monitoring • Radical prostatectomy- complications include incontinence, impotence and operative mortality • Radiotherapy- diarrhoea/bowel problems, impotence, incontinence • Adjuvant therapy- impotence, loss of libido, breast swelling and hot flushes

  17. Monitoring Treatment • PSA levels are used to monitor disease activity in those with established cancer • Can give an early indication of the progression of a cancer

  18. Population Screening • Calls for a national screening programme • Randomised controlled trials are needed • Definitive information from USA/European trial will be available later this decade. • Benefits and harms must be assessed

  19. Population screening • Potentially harmful effects of prostate screening are particularly significant • Screening would lead to some men(with indolent disease) suffering from impotence, incontinence and death who would not have done so had screening not been introduced

  20. Conclusions • To date, no good evidence to say whether or not screening would reduce mortality • Men who ask about PSA test need balanced information to make an informed decision • Ref: Prostate Cancer Risk Management Programme

More Related