Thanks to Waise Ahmed for suggesting this case.
A 61 year old man, seeing his Family Doctor.
The serum PSA was 7.6 ug/L (Abbott IMX, reference range up to 4 ug/L). The
clinical information is 'raised PSA'.
Previous results on this patient were
6.7 ug/L, 9 months previously
5.7 ug/L, 16 months previously
5.4 ug/L, 23 months previously. The clinical information then was 'mild
prostatism'.
This Case attracted 41 participants, almost a record. These fell into
three
neat groups, two sitting on either side of the fence, and one sitting
firmly on top of it.
Only 3 participants would 'phone the Family Doctor to discuss the
Case[0.2];
2 participants would not comment on these results[-0.8].
2 participants commented that the PSA results were significant for this
age[-0.2];
1 commented that they were normal for this age[-1.1].
4 participants suggested a persistent/ more rapid/ significant rise in PSA
than expected for benign prostatic hyperplasia[0.6];
14 suggested prostatic malignancy[0.2];
4 thought that prostatic cancer was unlikely[-0.6];
11 suggested benign prostatic hyperplasia[0.1];
2 suggested prostatitis[-0.5].
7 suggested a digito-rectal examination[0*];
24 suggested referral for urological assessment/ biopsy and rectal
ultrasound[1.6];
2 suggested referral to a surgeon[-0.8];
12 would suggest measuring free PSA and the free/total ratio to
distinguish
prostatic cancer from BPH[+1, but one assessor commenting that this was
unlikely to be available locally};
1 participant suggested repeating the PSA[-0.2];
1 suggested monitoring at regular intervals[-0.2];
1 queried measuring PSA four times in this patient within two years[-0.3];
and 1 said that PSA was unreliable in the diagnosis of prostatic cancer
because of the high incidence of false positives[-0.8].
Best wishes
Li Ping, Gordon Challand
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