Prostate: Investigations, Diagnosis, Staging and Grading Flashcards
1
Q
What is PSA testing?
A
- Prostate specific antigen
- All men have some PSA but high levels can indicate cancer
- PSA is secreted by epithelial cells when turn cancerous more PSA leaks out
2
Q
What is considered raised PSA?
A
- 3ng/mL or above is considered high
3
Q
What does high PSA levels mean? How can PSA levels be raised?
A
- Could be vigorous exercise (cycling e.g.)
- Recent ejaculation or stimulation of the prostate gland via anal sex
- Medications
- UTI
- DRE before a PSA could lead to increased PSA levels
- A prostate biopsy can raise PSA level for up to 6 weeks
4
Q
What does an enlarged prostate mean for diagnosis?
A
- Prostate naturally enlarges with age
- Benign prostatic hyperplasia= increased number of cells
- Benign prostatic enlargement = increased size of the gland
- Both might lead to similar symptoms as prostate cancer but are benign
- TURP = a resection of the prostate to relieve symptoms
5
Q
What are the advantages of PSA testing?
A
- Early diagnosis
- Treatment options are available earlier (e.g less area for RT)
6
Q
What are disadvantages of PSA testing?
A
- False negatives -> 15% false negatives
- False positives -> 75% negative biopsy
- Could lead to unnecessary investigations, e.g. biopsies are invasive
- Could it lead to unnecessary treatment, some cancers are never significant
- Causes stress and anxiety
7
Q
What are the issues with screening?
A
- Conflicting opinions
- Unnecessary diagnosis
- Risk management is a form of screening?
8
Q
What is a DRE?
A
- Following a high PSA test a DRE will be performed
- Digital Rectal Examination
- Prostate nay feel, normal, enlarged, hard or lumpy
9
Q
What are limitations of a DRE?
A
- if tumour is located anteriorly or centrally it may not be felt
- Some patients may find uncomfortable
10
Q
What did the PROMIS study do?
A
- determine if the mpMRI can identify men with clinically significant prostate cancer
- Is it more accurate than a biopsy
- Can patients be triaged via mpMRI
- It reduced over diagnosis and unnecessary biopsies
11
Q
What do mpMRI gradings mean?
A
- 3+ = needly placement is guided by the mpMRI and ultrasound biopsy will be given
- 1 or 2 it is a discussion with the patient, cannot be ultrasound guided.
12
Q
What is a TRUS biopsy?
A
- TRUS = transrectal ultrasound biopsy
- Ultrasound probe inserted
- sometiemes general anaesthetic
- 10-12 samples taken
13
Q
What are advantages of a prostate biopsy?
A
- 11-28 in every 100 people with low risk mpMRI actually have prostate cancer
- If aggressive cancer can be detected at early stage
14
Q
What are disadvantages of a prostate biopsy?
A
- Still miss a lot of cancers
- Insignificant cancers identified
- 1 in 100 people develop sepsis
15
Q
What is a transperineal prostate biopsy?
A
- Ultrasound into rectum
- Needle through perimeum
- Template biopsy placed over the skin and 2-3 cores are samples
- LATP adopted throughout pandemic
