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The next generation in prostate health testing—Prostate Health Index (phi)—is now available from SNP. phi significantly raises diagnostic accuracy for prostate cancer over currently available tests.A new marker for prostate cancer— truncated proPSA (p2PSA)—has recently become available. This molecule circulates as part of the Free PSA fraction; in patients with prostate cancer it is present as a higher proportion of the Free PSA fraction. A greater specificity for cancer detection was found when proPSA was combined with Free PSA and Total PSA in a calculation known as the Prostate Health Index (phi).
phi adds additional advantages to PSA testing in prostate health assessments:
• phi is minimally affected by a man’s age, unlike current PSA tests.
• phi can also preferentially detect the more aggressive cancers which are likely to grow and spread more rapidly.
• phi can assist patients and doctors to make a more informed decision about proceeding with a prostate biopsy.
phi is likely to be most useful in men where the Total PSA result is mildly elevated (2–10 μg/L). Determining the cancer risk in this range can be difficult, with up to 25% of new prostate cancer patients having a relatively normal PSA (< 4 μg/L); on the other hand, 60–70% of men with a PSA value > 4 μg/L have a benign biopsy result. Because of this uncertainty, a prostate biopsy is often considered necessary to clarify the diagnosis.
• It is envisaged that this test may assist in reducing the number of unnecessary biopsies in these patients.
• The role of phi in other clinical situations, such as follow-up of radical prostatectomy, has not yet been established.
About the Author − Dr David Kanowski FRCPANew prostate cancer testing brochures for patientsWith patients becoming increasingly interested in new advances in prostate testing, SNP’s new brochure,ProstateCancerTesting−Don'tbecaught out, provides new information about PSA for men to make a more informed decision about proceeding with a prostate biopsy.
Order your copies of Prostate Cancer Testing and a waiting-room poster on your next stores order, or contact your Medical Liaison Manager
1300 SNPATH (1300 767 284).Item 09441Brochure−ProstateCancerTestingItem 09465 A3poster−ProstateHealthIndex
What to request: phiCost: phi cannot be bulk billed as Medicare Australia does not provide a rebate. Patients will receive an account for $95.*
For your copy of the new phi bulletin, phi guide or phi flyer for patients, contact your local
Medical Liaison Manager on1300 SNPATH (1300 767 284).
SULLIVAN NICOLAIDES PTY LTD • ABN 38 078 202 196 134 WHITMORE STREET • TARINGA • QLD 4068 • AUSTRALIA
TEL (07) 3377 8666 • FAX (07) 3870 0549 P O BOX 344 • INDOOROOPILLY • QLD 4068 • AUSTRALIA
DOCTOR SERVICE CENTRE 1300 SNPATH (1300 767 284)
Dr David Kanowski is a graduate of The University of Queensland, where he completed an honours degree in biochemistry before studying medicine. After graduating in 1985, and a short period in the UK studying anaesthetics, he returned to Brisbane to train in chemical pathology. David joined Sullivan Nicolaides Pathology in 1997.Dr Kanowski is available for consultation.T: (07) 3377 8779 E: [email protected]
syzygyDecember 2011
Newadvanceinprostatehealthtesting−
PROSTATE HEALTH INDEX
To improve certainity of diagnosis of peanut allergy, SNP now offers the next generation of allergy tests that use recombinant peanut protein. When combined with traditional peanut RAST® (allergy) testing, this gives much greater knowledge about peanut allergy and the risk associated with it.
Peanut sensitivity (any positive blood or skin test) occurs in up to 10% of children, with true peanut allergy occurring in 1–2% of children world-wide, though this figure may be higher in Australia. Over the period 2002–2007, peanut allergy doubled in incidence in Australia, and admissions to hospital rose 4–5 fold. Anaphylaxis occurs in around 10% of children with confirmed peanut allergy, though
traditional tests (either skin or blood) give only a rough guide to this. However, it is of concern that current tests over-diagnose peanut allergy.
Further research by various groups has shown that allergy to Ara h2, a peanut protein, gives the greatest risk of being allergic and of having a severe reaction. When used in conjunction with a peanut RAST®, this is able to give a risk profile for an individual.
The timing of testing may be important; testing years after an allergy occurred will be more complex. Unfortunately, in allergy no test is 100% accurate, though progress towards a better test is being made.
Diagnosing peanut allergy can be challenging − until now
Your Pathologist −Dr Daman Langguth FRACP FRCPA
Dr Langguth is a clinical pathologist who trained in rheumatology and immunology in Perth and Brisbane. His areas of expertise are auto-immune disease, allergy and immune deficiency. Dr Langguth is available for consultation.T: (07) 3377 8698E: [email protected]
Haemoglobin A1c (HbA1c) has a well-established reputation as the best marker for long-term diabetes control. Elevated blood glucose levels result in the formation of glycation products with haemoglobin that reflect the time-averaged glucoselevelsovertheprevious2−3months.Measurementof these compounds has given clinicians a powerful tool in the management of diabetes mellitus.
However, the old HbA1c units are no longer scientifically valid. New analytical standards for the measurement of HbA1c are better defined, and give lower results than the values currently used. In fact, the new standard has been used in laboratory measurement for some years, and the HbA1c results currently being reported are adjusted upward to match the old standards. For example, a value of HbA1c that is reported as 7.0% is actually derived from a measured value of 5.3% that has been adjusted upwards.
To address this discrepancy, the International HbA1c ConsensusCommitteehasrecommendedthatallHbA1cresults should be reported in SI units. This results in values that are sufficiently different from the old system to prevent clinical confusion. For example, rather than reporting a value that was previously 7.0% as 5.3%, the new system will report this as 53 mmol/mmol. In addition, this change will avoid the misconception that the HbA1c value represents an average blood glucose level.
This change has already been implemented in New Zealand and a number of countries in the European Union. Results will be reported in both units for 2 years, to allow time for clinicians to get used to the new values. The old values will be indicated as belonging to the previous standard, the National Glycohemoglobin Standardization Program (NGSP); the new values will be reported as conforming to the International FederationofClinicalChemistry(IFCC)standard.Thefollowingtable gives a comparison of the old and new units:
Conversion table for haemoglobin A1c (HbA1c) values
HbA1c (% − old units)
HbA1c (mmol/mmol − new units)
5.0 316.0 426.5 487.0 538.0 649.0 7510.0 8611.0 9712.0 108
A more in-depth discussion of this topic, including recommendations for HbA1c target ranges, is available in an MJA article published in July this year (Jones GRD et al, MJA 195(1), 45-46).
Dr Greg Ward MSc BSc (Hons) FAACB FFSc(RCPA) MAACBGreg Ward is Department Head of Biochemistry at Sullivan Nicolaides Pathology.
He has extensive experience in pathology laboratories, both in the public and private sectors. Greg has presented and published a wide variety of papers on the application of biochemical techniques used in clinical endocrinology.
For further information about HbA1C contact:Dr David Kanowski T: (07) 3377 8779 E: [email protected]
Dr Lee Price T: (07) 3377 8672 E: [email protected]
Dr Greg Ward T: (07) 3377 8531 E: [email protected]
New SI units for HbA1c reporting − mmol/mmol Dr Greg Ward
To order your copy of the Peanut Allergy risk assessment brochure (Item 09445) contact your Medical Liaison Manager on 1300 SNPATH (1300 767 284) or request one with your next 'Doctor Stores' order.
What to request: Peanut Allergy risk assessment
Cost: Medicare rebate + $47.50* (Please note that this is a complex test and bulk billing is not available)
Diagnosing peanut allergy can be challenging − until now
Holter monitoringAsanormalECGreadingdoesnot necessarily always rule out serious heart disease, referring your patient for a 24-hour Holter monitor will provide you with a better understanding of how their heart is performing during the variety of activities that they do in a day.
Holters are fitted at designated SNP collection centres and patients are given a diary to record specific symptoms or anything unusual that occurs while they are wearing the Holter.
Holter traces are reviewed by a specialist cardiologist; you will receive their final report including a summary, the full printed 24-hour disclosure and the patient diary.
High blood pressure typically develops without signs or symptoms. Because blood pressure normally varies throughout the day, and sometimes specifically during visits to the doctor ('white coat' hypertension), a single high blood pressure reading may not be enough for a diagnosis.
Accurate diagnosis should be based on more than one reading, taken on more than one occasion; it may assist diagnosis to have blood pressure measurements taken regularly, over an extended time period and covering a range of activities. Ambulatory Blood Pressure (ABP) measurements give a better prediction of clinical outcome than clinic or casual blood pressure measurements. The technique of ABP monitoring (ABPM) is specialised; validated monitors and appropriate quality control measures should always be used.
You may want to consider an ABPM for one or more of the following reasons:• diagnosing hypertension prior
to prescribing anti-hypertension medication
• for borderline and difficult to control high blood pressure
• for patients with fainting spells• to exclude 'white coat' hypertension
(which requires continued surveillance; patients who display this phenomenon may, in time, develop established hypertension)
• to aid in the assessment of apparent drug-resistant hypertension, symptomatic hypotension or hypertension in the elderly
• to assess adequacy of control in patients at high risk of cardiovascular disease
• for patients with end-organ damage associated with hypertension (which is more closely related to ambulatory blood pressure).
Dr Price is available for consultation.T: (07) 3377 8672 E: [email protected]
Cardiology services 24-hour holter and 24-hour ambulatory blood pressure monitoring for elective investigations are now performed by appointment at designated SNP collection centres.
Ambulatory Blood Pressure Monitoring (ABPM)
What to request?24-hour Holter monitor
What is the cost for Holter monitoring?*
Bulk billing is not available for this service.
The patient will receive an account after the service. Private fee = Medicare Rebate + $95* out-of-pocket patient contribution.
Concessionalfee=Medicarerebate + $47.50* out-of-pocket patient contribution (Pensioners,HealthCareCard,CommonwealthSeniorsCard).
DVA = billed direct to DVA.
Holter monitoring is eligible for and contributes to the Medicare safety net.
Supervising Specialist − Cardiology Services Dr Lee Price FRCPA FRACPDr Lee Price graduated from The University of Queensland in 1986 and completed his residency, a fellowship in chemical pathology, and advanced physician training at Princess Alexandra Hospital. He has worked as a specialist pathologist for the past 16 years.
Holter and blood pressure monitoring are available by appointment at designated collection centres. To locate the most convenient centre for your patient visit snp.com.au >locations >collection centres. Select ‘blood pressure’ or Holter monitor’ from the specialised test menu, or with your web-enabled camera phonescantheQRCodewithaQRCodereaderapplication.
What to request? 24-hour blood pressure monitor
What is the cost for blood pressure monitoring?* This service cannot be bulk billed as Medicare does not rebate ABPM.The patient will receive an account after the service. Private fee $95* out-of-pocket patient contribution. Concessionalfee=$47.50*out-of-pocketpatientcontribution(Pensioners,HealthCareCard,CommonwealthSeniorsCard).DVA = billed direct to DVA.
*Fees correct at time of printing and subject to change without notice – December 2011Comments and Feedback? Contact us at [email protected]
SULLIVAN NICOLAIDES PTY LTD • ABN 38 078 202 196 134 WHITMORE STREET • TARINGA • QLD 4068 • AUSTRALIA
TEL (07) 3377 8666 • FAX (07) 3870 0549 P O BOX 344 • INDOOROOPILLY • QLD 4068 • AUSTRALIA
DOCTOR SERVICE CENTRE 1300 SNPATH (1300 767 284)
Syzygy – now on 100% recycled paperSullivan Nicolaides Pathology recognises our corporate responsibility to respect and improve
the environment in which we work and live. As part of our commitment to continually improve environmental performance and prevent pollution, Syzygy is now printed on 100% recycled paper.
Are your patient collection notes current?We appreciate that for many patients the idea of collecting a specimen for pathology tests may be daunting. We provide a series of patient notes to help them get the right sample the first time and avoid re-collections. These patient notes are updated regularly so, with the end-of-year tidy-up about to happen for most of us, it’s a good time to throw out the out-dated ones and order the latest versions.
To order new stock just call your Medical Liaison Manager on 1300 SNPATH (1300 767 284) or request them on your next
order for 'Doctor Stores'.
Collection Note Title/Content Version Date Item #Allergy tests July 11 03222Blood tests – venepuncture information August 11 41670Blood tests – fasting instructions October 11 29670Faeces micro culture & sensitivity August 11 12340Faeces Helicobacterpylori April 10 05231Faeces occult blood July 11 62710Glucose Tolerance Test for gestational diabetes October 11 05229Glucose Tolerance Test October 11 11720Group B Streptococcus swab self-collection August 11 05792Hydrogen breath test October 11 47860Pin worm sticky tape test April 10 58700Semen collection and transportation October 11 11610SputumMCS August 11 12310Sweat Test April 10 07696Therapeutic drugs July 11 84530Urea breath test October 11 97240Urine 5-HIAA October 11 00006Urine micro culture & sensitivity August 11 11770Urine sexually transmitted diseases May 11 98090Urine Drug Screen medico-legal, rehabilitation and employment
April 10 05861
Collection Centre New LocationsBrisbane – now open Eatons HillRegional – now open BundabergToowoomba
For a full list of collection centres and the opening hours, visit
www.snp.com.au
Warfarin Care Enrolment now closed until 3rd January 2012To ensure the safe and complete enrolment of patients into our Warfarin Care Program, enrolments closed on Wednesday 7th December 2011. Enrolments will re-open at 9 am on Tuesday 3rd January 2012.
For more information about Warfarin Care, please contact our Warfarin Care team on (07) 3377 8578, or visit www.snp.com.au (Doctor Services tab).
