Lecture 12 - Screening Tests

if prostate cancer is found early AND/OR slow-growing type it may be what?

more dangerous to remove than observe

opprotunistic screening - subtypes of screening

pt comes in for some other reason (STD screening at visit for OCP refill) and they have hep C when drawing blood for something else

What is it?

A sweep with a little soft broom of cells (gets loosely attached cells) and ideally get them from the outside of the cervix (exctocervix) and get endocervical cells in the begging of the canal There is a junction between those cells and sometimes moves back and forth over time But because so much cell turnover = more DNA replication = which is a risk factor for something??? Super important to get that transition zone!!

BPH beningn prostatic hypertrophy/hyperplasia

BPH: hypertrophy or hyperplasia can be called = both are increased cell size and increased # of cells Happens so frequently that its been called ubiquitous in old men

data mining/registries - subtypes of screening

Some health systems (eg Kaiser) or even whole countries can use data mining/registries to actively find patients at risk ***better system that follows them for years (better technique at screening example)

by the type males hit 80s, its about ____+% w. prostate cancer

80+%

Small prostate but high PSA Why would this be more concerning than a high PSA and a normal prostate?

(cuz not releasing enough per unit of prostate)

ultrasound is done if a PSA is abnormal or in a grey area, which is done in the prostate and the density is calculated. If the prostate is small and releasing a lot of PSA - is this a bad or good sign?

(if prostate is small but releasing a lot of PSA = this is not a good sign as if it hypertrophied and making a lot more) **so might just be related to BPH if it's a big size **it might be associated with prostate cancer if it's a small size?

PSA per AUA: Very valuble test but not a single cut off value anymore, what factors are they taking into account now in order to biopsy pts that are asymptomatic?

-DRE results -age -ethnicity -comorbidities -prior biopsy hx -prior serum PSA level

prostate cancer

-very common difficult condition to diagnose in some ways Many people have it, but there are 2 paths it can take (can take decades to grow or it can be rapidly growing = and it's the 2nd leading cause of death in men)

PSA modifcations - some of these can help in gray areas: what 3?

1.) PSA density 2.) velocity 3.) free/complexed ratio

What are the 3?

1.) case finding 2.) data mining/registries 3.) opportunistic screening

In terms of follow-up testing, here is was to do when something is abnormal - LIST THE STEPS.

1.) repeast the PSA **if its in a grey area or slightly abnormal Or accelerated testing (do it more 2.) compare volume and density 3.) compare free or bound More free than bound = good sign 4.) ultrasound-guided biopsy This is whether it's **listen to lecture A lot of providers still do rectal exam =only checking a small space of the prostate And can sometimes cause an elevated PSA if its done right after that or the next day

Prostate specific antigen (PSA)

blood test that measures the level of prostate-specific antigen in the blood = looking for prostate cancer

free/complexed ratio

cancer-related PSA more likely to be bound

case finding - subtype of screening

certain portions of the population targeted for screening based on risk factors (partners of pts with STDs, etc.)

Screening vs. diagnostic: cost

screening: -cheap diagnostic: -higher costs

Screening vs. diagnostic: positive result threshold

screening: -generally chosen towards high sensitivity not to miss potential disease diagnositic: -chosen towards high specificity (true negs) -more weight given to accuracy/precision than to pt acceptability

Screening vs. diagnostic: test method

screening: -simple -acceptable to pts/staff diagnostic tests: -maybe invasive -expensive -BUT very justifiable because its probably necessary to establish diagnosis

Screening vs. diagnostic: positive result

screening: indicats suspcision of disease that warrnt confirmation (usually also have risk factors too) diagnostic: result provides DEFINITE diagnosis

Screening vs. diagnostic: target population

screening: large numbers of asymptomatic **but potentially at risk individuals diagnostic: symptomatic individuals to establish diagnosis OR asymptomatic individuals w. a positive screening test

Screening vs. diagnostic: purpose

screening: to detect POTENTIAL disease indicators diagnositc: to ESTABLISH presence/abscence of disease

velocity?

some variation normal over time. 3 measurements over 2 yr period

What is the primary purpose of screening tests?

to detect early disease or risk factors for disease in large numbers of apparently healthy individuals **trying to test large number of people (cheap, quick and sensitive)

What is the primary purpose of diagnostic tests?

to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test) **Confirm suspicion from screening test with diagnostic testing

psa density takes into account what?

volume of prostate

age makes a difference in prostate cancer screening, so _____ men should NOT have BPH to blame for an elevated PSA. Therefore normal range changes with age.

younger

Guidelines for PSA in prostate cancer screening: PER AUA age <_____: none ages ___-___: none unless high risk ages ___-___: PSA, with add. testing if abnormal to ID more aggressive types Q2 year interval may be preferred if normal age >_____ or less than 10-15 yr lifespan: none unless in "excellent health"

•Age < 40: none •Age 40-54: none unless high risk (AA, family history of aggressive or early onset prostate cancer, other adenocarcinomas or in multiple members) •Age 55-69: PSA, with additional testing if abnormal to ID more aggressive types •Q2 year interval may be preferred if normal •Age > 70 or less than 10-15 yr lifespan: none unless in "excellent health"