Wednesday, July 23, 2008

Screening for prostate cancer

When should screening start?
The ACS recommends that physicians should discuss PSA screening with their patients over age 50 and with a projected life expectancy of 10 years or more. In this discussion the morbidity of treatments for prostate cancer should be addressed. African Americans or those with a family history, should start screening start at 40. The question of whether screening saves lives is still not resolved, but is the subject of an ongoing NCI sponsered trial.

Interpret action of PSAs
  • prostatic index - keyed to size of the gland
  • age specific PSA - PSA normally increases with age, therefore a level of 4 has a different meaning in a 40 compared to 70 year old man.
  • free vs. bound PSA

Use of PSA with DRE and ultrasound (ultrasound is often performed to guide transrectal needle biopsy.

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