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Elevation of prostate-specific antigen

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Urology, Epidemiology
Progress Test Topic(s)
Renal
Description
A 65 year old Dutch male, a retired plumber, has a history of a slow stream of urine and needing to get up to void once or twice in the night. He has been referred to the Urology Outpatient Clinic after a blood test showed an elevated prostate-specific antigen.
Applied Science for Medicine 
   - Anatomy and physiology of micturition and its disturbance with outflow obstruction
   - Genetic, molecular and cellular differences between normal prostate gland, benign and neoplastic growth
   - Hormonal control of prostate growth and its role in benign prostatic enlargement and cancer
   - Pathological basis of tumour markers
   - The evolution of cancer: pre-cancerous to cancer to metastatic disease
   - Pharmacology of alpha adrenoceptor blocking drugs and hormonal treatments including 5-alpha-reductase inhibitors for benign prostatic hyperplasia
Clinical and Communication Skills 
   - Elicit a relevant genitourinary history relating to lower urinary tract
   - Communication regarding potentially embarrassing symptoms
   - Perform a focused examination relating to lower urinary tract and prostatic symptoms
   - Perform, with sensitivity, a digital rectal examination
   - Interpret full blood count, renal function tests, prostate specific antigen (PSA), midstream urine, ultrasound, pathology report of transrectal/prostatic biopsy
   - Causes of an elevated PSA
   - Common organisms that cause prostatitis and suggest appropriate antibiotic treatment
   - Management of benign prostatic hyperplasia
   - Stage prostate cancer using the TNM system, incorporating the Gleason score
   - Outline the management of prostate cancer: active surveillance, radical prostatectomy, radiotherapy, hormonal and chemotherapy, palliative
   - Outline the potential complications and management of patients following prostatic surgery
   - Management of long-term catheters in the community
Personal and Professional Skills 
   - Self-awareness regarding managing diagnosic uncertainty
   - Social stigma around urinary tract conditions
   - Influence of patient's health status and opinions on choice of therapy
   - Intimate examination and use of a chaperone
Hauora Māori 
   - Inequities in prostate cancer rates and mortality between Māori and non-Māori
   - Inequities in access to timely cancer care for Māori, and application of this to clinical decision making and management
   - Understanding of the role of kaupapa Māori cancer services and research in reducing inequalities
Population Health 
   - Epidemiology of prostatism
   - Costs and benefits of PSA tests
   - Effectiveness and cost-effectiveness of PSA screening in the general population
   - Communicating risk - sensitivity, specificity, predictive values and likelihood ratios
Conditions to be considered relating to this scenario
Common
benign prostatic hypertrophy, prostate adenocarcinoma, prostatitis, perineal trauma (post catheter insertion, post-procedure including rectal examination, sexual activity), urinary tract infection
Uncommon
salivary gland tumours (as cause of raised PSA)