PSA communication station

John, a 40 year old, comes to the GP practice today with concerns about
prostate cancer. He saw a programme about it and has seen some
similarities with himself and the men on the programme. Discuss any
concerns he has.

Hi John, I understand that you are here to discuss your concerns

about prostate cancer. What is that you wanted to discuss today?
let them explain their main concerns then find out more
He explains that he has some of the symptoms need to qualify the
LUTS
o Does he have to rush to goto the loo?
o What is the stream like? Stop/start?
o Pain
o Blood or discolouration
o Stinging
o Dribbling after
o Is there time before where he is waiting to start urinating?
o If any of these when did they start? Have they been
persistent? Or only on certain occasions?
o Is he going to the loo more often? Polyuria can be a sign of DM
may need to find out if he has ever had a dx, what are the
risks of him getting DM? Only ask if you think it is relevant!
o Ever had any UTIs in the past?
o Check for any past history for problems with the prostate
o ALWAYS ask how they are feeling in themselves now
He mentions hearing about PSA and wants you to explain what this
is.
o PSA is a protein that is released from the prostate gland. The
prostate gland surrounds the neck of the bladder when it
gets bigger or inflamed it can sometimes block the flow of
urine. Reasons for it getting a bit bothered or a little bit big are
when it gets infected, the surroundings get infection so an
infection of your water pipe, it can get bigger as you age and
in some men this can be earlier than others we call this BPH,
and it may change shape or get bigger if there is prostate
cancer.
o So we can investigate what is causing the symptoms we
discussed earlier by examining the prostate, testing your urine
and doing a blood test.
o DRE explain ?
o The blood test will involve testing for what we call PSA. This is
a protein that is released from the prostate and makes part of
the semen by liquefying it. It can be raised in certain
conditions and will be detected in the blood. These include an
infection of the prostate gland, enlargement of the prostate
gland, if there has been any trauma to the prostate so for

men who have had any procedures involving the gland and it
can be raised in prostate cancer.
o PSA can be raised when there is actually no problem with the
prostate so can lead to further testing that you may not
require.
o I know that you were anxious about getting prostate cancer so
I would like to explain that if you were to have a raised PSA it
does not always mean that you have the cancer. If you did
have a raised PSA we would refer you to the specialist team in
the hospital who will do further investigations.
o These investigations will include things like examining your
prostate clinically where they will place a finger in your back
passage and feel your prostate gland for any abnormalities or
changes.
o They may also do a TRUS biopsy this is a trans-urethral US
biopsy. It will involve a cystoscope being placed into your
water pipe/ urethra and the doctor will take biopsies of your
prostate. If you were to have this, you would have some LA to
numb the area so you wouldnt feel a thing. You may
experience some symptoms after it such as bleeding which is
the most common, you may get an infection and in very few
cases as it does involve anaesthesia it may cause death but
Id like to emphasise this is in very few patients.
Patient explains that his brother had prostate cancer ask if he
doesnt mind sharing the outcome. Then explain the familial
inheritance.
Risk factors to developing prostate cancer
o Some ethnic groups such as Afro-Caribbean and AfricanAmerican men are at increased risk
o Genetics having a first degree relative doubes the chance of
getting prostate cancer and having more than 2 relatives
increases the risk more than 4 fold
o If they mention any genes may mention BRCA 1 and BRCA 2
which are associated with breast and ovarian cancer in women
o People with Lynch syndrome are at increased risk of
developing cancers generally and are at an increased risk of
getting prostate cancer
o Modifiable risk factors obesity, diet, smoking
Offer the patient a follow up if he does get referred to the specialist
team and follow him up!