Prostate cancer screening: Your questions answered

2 minute read

A urologist answers questions about the PSA, family history, biopsy and more.

Dr David Lim speaks with Professor Jeremy Grummet to answer your most commonly asked questions.

The questions answered in this podcast 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? 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. Should we routinely check PSA for men >50 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 – should he have PSA testing?
  8. Is a PSA level of 3 used as cut off across age groups?
  9. How do you screen people with family history?
  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 transperineal 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 don’t we do MRI screening rather than PSA?
  18. For patient with PSA > 3, if a 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?

Host: Dr David Lim, GP and medical educator

Guest: Prof Jeremy Grummet, Urologist

Total time: 43 mins

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