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Prostate Biopsy Decision Factors

The Saskatchewan Prostate Assessment Pathway provides urologist-approved guidelines to help you decide on the best care pathway to recommend for your patients, according to existing risk factors.

When to refer your patient to a urologist
(video coming soon: Saskatoon urologist Dr. Kishore Visvanathan explains the decision-making process to help determine if your patient should be referred directly to a urologist.)

Prostate-Specific Antigen Levels
Normal Age-Specific PSA Levels (CUA 2011)

Age PSA Level (Upper Limit)
40-49 2.5 ng/ml
50-59 3.5 ng/ml
60-69 4.5 ng/ml
70 and older 6.5 ng/ml
PSA screening for men over 70 years is not recommended.

PSA fluctuation
PSA levels are subject to considerable variation. Variation can be caused from irritation or trauma such as bladder or prostate infection or after instrumentation (i.e. catheter insertion), thus causing a false-positive PSA level. See PSA Fluctuation Evaluation by The Journal of the American Medical Association.

Treatment of prostate or bladder infection
Since PSA levels may increase as a result of a prostate or bladder infection, if a PSA level has been collected during a suspected or known prostate or bladder infection, a repeat PSA level should be drawn eight weeks after the completion of antibiotic treatment. If the PSA level remains elevated, further investigation for prostate cancer may be warranted.

Patient life expectancy
If a patient has a life expectancy of less than 10 years, further assessment/treatment may not be appropriate. Discuss this with your patient before screening or assessing for prostate cancer.

Urologist referral
This table indicates situations where referral to a urologist before biopsy should be considered for patients. Staff in a Prostate Assessment Centre will also refer patients directly to a urologist if concerns are detected.

Question: If yes, refer to urologist before ordering biopsy
Is the patient under 40 years or over 75 years, with elevated PSA? Patients in these age groups require further assessment to determine if a prostate biopsy is necessary. If a patient is over 75 years, a prostate biopsy may not be appropriate.
Does patient have a PSA value greater than 50? A diagnosis may be possible based on clinical findings, avoiding the need for a biopsy.
Does the patient have an abnormal digital rectal exam but PSA value is normal? A urologist should assess the prostate to determine if the abnormality warrants a biopsy.
Has the patient had a previous biopsy? With a previous negative prostate biopsy, subsequent biopsies may not be necessary. The likelihood of a positive finding is less likely with each subsequent biopsy.
Is the patient immunocompromised? Additional preparation may be required prior to a biopsy.

 

See prostate biopsy patient preparation guidelines provided by the assessment centres in Regina and Saskatoon on the Prostate Resources for Providers page.

 

   
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