Patient Education

Question 1

Prostate Cancer Screening Joint Decision Making Points

Answer 1

• Potential for testing PSA from 50 years of age to 69 years of age every 2 years.

Benefits
- Reassurance with negative PSA
- Early detection and treatment of prostate cancer.

Risks
- False-positive results
- For every 10 man who have an abnormal PSA results, 7 will not be diagnosed with prostate cancer after further investigation.
- Overdiagnosis can lead to worsening mental health and depression.
- Overtreatment can lead to impotence, urinary incontinence or other surgical complications.

Summary of effect of testing
For every 1000 men tested via PSA
- 2 will avoid death from prostate cancer before 85yo
- 87 men who will not have prostate cancer will have a false positive PSA result that will lead to a prostate biopsy
- 28 men will experience a side effect from the biopsy.
- 28 men will be diagnosed with prostate cancer, many of whom would have remained asymptomatic for life.
- 25 mean will choose to undergo treatment (surgery / radiation)
- Up to 10 of these men will develop persistent symptoms such as urinary incontinence

Many prostate cancers are indolent, which means that untreated they would never cause harm and would require no treatment. Finding the prostate cancers that are worrisome is not able to be performed with current screening methods.

Question 2

PSA testing contraindications

Answer 2

Artificial elevators of PSA
- Active UTI
- Ejaculation in the last 48 hours
- Vigorous exercise in the last 48 hours
- DRE in the past week
- Prostate biopsy in the last 6 weeks.

Question 3

Management options following diagnosis of prostate cancer

Answer 3

Observation
1 - Watchful waiting - especially in older men with limited life expectancy
2 - Active surveillance - Active plan to postpone intervention. Monitoring for signs of disease progression.

Active Treatment
3 - Treatment with curative intent.
- Radical prostatectomy, radiation therapy, androgen deprivation therapy.

Question 4

Definition of a missed miscarriage

Answer 4

Missed miscarriage is a non-viable intrauterine pregnancy in the absence of vaginal bleeding.
- Sonographically defined as a gestational sac diameter >25mm with no obvious yolk pole with a CRL >= 7mm without evidence of cardiac activity.
- Uncertainty with borderline measurements will prompt a repeat scan in 10 days.

Question 5

Management of a missed miscarriage

Answer 5

Expectant
- Wait for natural loss of pregnancy to occur. A trial of up to 4 weeks can be taken. Can be emotionally draining. Proceed to medical or surgical intervention if does not occur within 4 weeks.,

Medical
- Use of misoprostol. 90% success rate. Allow avoidance of surgical and anaesthetic risk of surgical intervention. SE - Pain, nausea, vomiting, prolonged bleeding. Refer to a colleague GP with training in medical management of miscarriage.

Surgical
- Dilatation and curettage performed under general anaesthetic.
- Allows for predictable timing of completion of miscarriage and reduced recovery time.
- With D&C, products of conception can be sent for analysis.
- Risk - Small risk of damage to cervix or uterus, excessive bleeding and anaesthetic risk. Very rare risk of asherman syndrome which can cause uterine adhesions that can affect future fertility.

Question 6

Anti-D Injection Education in miscarriage

Answer 6

• If mother is RhD -‘ve and foetus is RhD +’ve, possibility of blood of foetus mixing with mothers blood can prompt an immune system response in mother against foetuses blood.
• Once these antibodies are created in the mother they cannot be removed. These antibodies can affect future pregnancies where the foetus also are RhD +’ve. Antibodies can cross the placenta and destroy the baby’s blood cells.