Guidelines Flashcards
At what age should PSA testing begin?
Age 50 (unless first-degree relative with prostate cancer - then age 45)
Test until 70
Can stop if life expectancy less than 10 yrs
Risks and benefits of PSA testing.
High false-positives: Only 1/4 positive results are d/t cancer
- Can be positive d/t prostatitis, enlarged prostate, UTI, recent medical procedure such as TRUS, urinary catheter, bladder exam, ejaculation, bike riding, warmer climates
False-negatives: PSA testing misses about 15% of prostate cancers
Normal PSA levels and frequency of testing.
PSA <1 = test q4 years
PSA 1-3 = test q2years
PSA >3 = more frequent PSA testing (use risk calculators, % free PSA)
What is the frequency of colon cancer screening?
Average risk: Age 50-74 w/ should be screened q2yrs with a FIT test
High risk: Age 50-74 w/ colonoscopy q10yrs
*For those with a family hx of colon cancer, the first screening colonoscopy should be done at age 40 or 10 years younger than the age of diagnosis of the youngest affected first degree relative - whichever is earliest.
Who should be tested for H. pylori?
Duodenal or gastric ulcer diagnosis (recent or in the past) without any prior testing or known cure
Dyspepsia (epigastric pain dominant symptoms)
Low grade MALT lymphoma
First-degree family history of gastric cancer (especially if index case is young)
High-risk groups (First Nations, immigrants)
How is testing for H. pylori done?
H. pylori can be diagnosed by histology when biopsies are taken during gastroscopy. The urea breath test (UBT) is a very accurate and robust test to diagnose the infection (pt needs to be off PPI for 14 days to prevent false negative result)
What is the treatment for H. pylori?
1st line:
(80-85% successful) ClAMet x 14 days: Clarithromycin, Amoxicillin, Metronidazole
(If PCN allergy) Bi-Quad x 14 days:
Bismuth, Tetracycline, Metronidazole, PPI
(Less well tested) 2nd line: PPI-AL
PPI, Amoxicillin, Levofloxacin (resistance to Levofloxacin is as high as 15% in Canada)
Is testing for cure required after H. pylori treatment?
Test 4 weeks after treatment is finished with UBT or stool antigen test.
If on PPI, hold for 14 days. Manage symptoms with antacids if required.
If the patient is negative after appropriate testing for cure was done, it is very unlikely such a patient will get re-infected later in life.
How is H. pylori testing done?
Urea breath test
Stool antigen assay (false neg if recent PPI (1 week), bismuth or abx use (4weeks) or actively bleeding ulcer)
Invasive - endoscopy
