The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia.
1. My patient was told by a doctor that duodart may cause cancer – thoughts?
2. What’s the utility of PSA in the monitoring for relapse of metastatic prostate cancer where treatment had been deemed successful at suppressing growth, but prostatectomy had not been performed? I know this is not a screening question as such, but it sounds like to me the oncology team is using PSA as a “screening” test for relapse in this patient in this context since he is not on active treatment?
3. How important is “above the mean” but < 3 PSA level mean?
4. What about rate of rise of PSA? Link with prostate cancer?
5. Are we routinely check PSA for men >50 year old every 2 years in general practice?
6. Will you do random sampling via transperineal biopsy for patients who are MRI contraindicated? Or is there another imaging modality e.g. PET scan
7. Healthy man of 70 year old, should or should not he have PSA testing?
8. Is a PSA level of 3 used as cut off across age groups?
9. People with family history – How do you screen? I learnt a few years ago 0.35 rise per year is acceptable more than that need to be investigated. What are the guidelines with or without family history to screen for prostate cancer?
10. Is the upper age limit for PSA likely to change given that men are living longer?
11. How many patients on active surveillance actually develop metastatic prostate cancer and missed the chance of curative treatment?
12. If PSA is >6, will the patient get Medicare rebate for repeating the PSA 1-3 months later? I was under impression PSA Medicare rebate is only available once every 12 months
13. What management or follow up is recommended for men with PSA within the normal range but above the median for their age group?
14. Why was the transrectal biopsy ever done instead of trans perineal from the get-go? Is it technically easier?
15. What MRI is recommended for detecting prostate cancer?
16. How far are we to use AI for reporting MRI prostate?
17. Why we don’t do MRI screening rather PSA
18. For patient with PSA > 3.0, if repeat test after 1-3 months showed PSA < 3.0, do we repeat screening again in 2 years, or earlier?
19. What are some comments you might have about risk mitigation in the diagnosis of prostate cancer?
Guest: A/Prof Jeremy Grummet, Urologist
Host: Dr David Lim, GP and Medical Educator
Total time: 43 minutes
