Please find an anonymised summary of responses regarding PSA comments below
Best wishes,
Katie
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We have a standard comment that minor elevations (<10 ug/L) in PSA may be associated with non-malignant disease. We don't comment on results in patients who are being monitored
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We routinely add the following comment to the first raised PSA (<20) from primary care:
Raised PSA. If this is the first occasion, exclude UTI as a cause and repeat in 4-6 weeks before considering urology referral.
If prostate is abnormal on DRE, consider immediate referral.
If PSA is above 20 then we recommend immediate referral.
These were the results of discussions with our urologists.
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We don’t routinely add any additional comments at all beyond age related reference ranges and a standard comment to all as follows:
“Raised PSA results are seen in prostate cancer, BPH and prostatitis. Normal results can occur in intra-capsular PCa.”
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Our standard PSA comment for results within reference range is:
PSA method : Roche, Cobas.
Tumour markers are not absolute tests for malignancy. The tests are neither 100% sensitive nor specific, and should not be used for screening in the absence of strong clinical evidence. NEGATIVE tumour markers DO NOT EXCLUDE malignancy.
For elevated results we preface that with:
Urgent urological referral advised for
a) Elevated age specific PSA in men with a 10 year life expectancy
b) A high PSA (>20ug/L) in men with a clinically malignant prostate or bone pain.
Ensure UTI is excluded as a cause of raised PSA.
If the request comes from oncology/urology or we can see the patient has known prostate cancer, we don't report those comments except for the assay method.
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To all results:
The Prostate Cancer Risk Management Programme, as interim guidance, recommends the following cut-off values are used for the PSA test:
50-59 years greater than or equal to 3.0 ug/L
60-69 years greater than or equal to 4.0 ug/L
70 years and over greater than 5.0 ug/L
Concentrations <3.0 ug/L may be significant in men <50 years but there is no recommended cut-off for younger men.
We only comment on PSA's if we are asked. Our local cancer guidelines recommend to GP's that if they suspect Cancer they refer to the Urologists within the 2WW.
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The comment we automatically add to all PSA results at present is:
‘Apart from prostatic carcinoma, elevations in PSA be due to benign prostatic hyperplasia, urinary tract infection, prostatitis, digital rectal examination, instrumentation of the urinary tract, recent ejaculation and cycling.’
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We add a general comment to all our tumour marker requests – “Tumour markers are not diagnostic and are of most use in monitoring response to treatment and early detection of relapse. Normal values do NOT exclude malignancy.”
We do not add further comment as clinical information on the request form may be lacking. PSA results, along with most of our tumour marker results, are reported cumulatively and no further comment is added.
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