Examination: High PSA | No symptoms

Casebank Combined
1

Who you are:
You are FY2 in GP surgery

Who the patient is:
50 year old, male, came for his PSA test result.

What you must do:
Talk to the patient and address his concerns.

Data Gathering

  • I can see from my notes that you’re here to discuss your tests results, PSA, could you briefly tell us regarding your previous visit?
    • D: Why the PSA test was done for you?
    • P: It was done under well-man check. (Or patient might say my friend was diagnosed with prostate cancer.)
  • Prostate symptoms:
    • Frequently- Do you go to the toilet more frequently than usual?
    • Urgency- Do you need to rush to the toilet?
    • Hesitancy- Are you finding it difficult to start urinating? do you strain?
    • Stream- How is the stream? Weaker than usual
    • Leakage- After passing the urine do you have any dribbling or leakage?
    • Empty- After passing urine do you feel like you haven’t emptied your bladder very well?
    • Nocturia- Do you wake up in the night to go to the toilet?
  • Cancer symptoms- Back pain, Weight loss, Blood in urine
  • Risk factors
    • Anyone in family with prostate cancer (brothers?),
    • Eat red meat?
    • Smoking
    • Black ethnic orgin
  • MAFTOSA

Note: No prostate symptoms, no cancer symptoms, no risk factors, no MAFTOSA

Examination

  • Digital Recital Examination
  • Note: If manikin is absent in the cubicle: Patient will refuse the examination.
    • Don’t push the patient, know the reason.
    • D: Could I know why you don’t want to do the examination?
    • P: I’m feel uncomfortable right now, can we do it another day?
    • D: Yes
  • Examination Findings:
    • DRE: Bilateral prostate enlarged

Management

  • I examined you and found your prostate was enlarged on both sides.
  • Additional the prostate specific antigen (PSA) test that was done for you is elevated for the age (3.4 to 20). The PSA test is a blood test that can help diagnose prostate problems, including prostate cancer. It is not a perfect test. It will miss some prostate cancers, will detect some that would never go on to cause harm and can show a raised PSA level when there is no prostate cancer present. But one out of four ends up having cancer. That’s we’re suspecting prostate cancer in your case.
  • Suspected cancer pathway (within 2 weeks)
  • We would like to refer you a specialist (urologist) for magnetic resonance imaging (MRI) scan of the prostate. Depending on the MRI result, you may then need a biopsy. A biopsy involves taking small samples of your prostate, usually through your back passage or perineum (the skin just in front of the anus), and checking them for cancer.
  • If further investigations show you have prostate cancer, your specialist will discuss the most appropriate follow-up for you. Regular follow-up (also known as monitoring or surveillance) can be an option for many men who have cancer confined to the prostate gland. Regular follow-up can include blood tests, clinical examination, MRI imaging scans and biopsies. Other options can include surgery, radiotherapy and hormone therapy.
  • Leaflet

Literature:

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