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Uro-oncology – an Update. Kieran Jefferson Consultant Urological Surgeon UHCW. BMI Meriden Hospital. Warwickshire one-stop haematuria clinic. BMI Meriden Facilities Proximity to UHCW allows rapid turnaround of blood samples 64-slice on-site CT scanner - PowerPoint PPT Presentation
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Uro-oncology – an Update
Kieran JeffersonConsultant Urological Surgeon
UHCW
BMI Meriden Hospital
Warwickshire one-stop haematuria clinic
• BMI Meriden Facilities
• Proximity to UHCW allows rapid turnaround of blood samples
• 64-slice on-site CT scanner• Size of facility allows one-stop cystoscopy
Warwickshire one-stop haematuria clinic
1. Clinical assessment by Consultant Urological Surgeon
2. Blood and urine sampling
3. Renal tract USS + CT Urogram (frank haematuria)
4. Flexible cystoscopy and discussion of results
Warwickshire one-stop haematuria clinic
• www.wonestop.com or www.warwickshireurology.com
• We commit to see referrals on a one-stop basis within 48 hours of referral
PCA-3
• Prostate cancer 3 over-expressed in prostate cancer
• Non-coding RNA; 9q21-22
• DRE releases prostate cells into urine
• Urine sample sent for central analysis using RTqPCR
PCA-3
PCA-3 assay
1. Bead capture of mRNA
2. Amplification of captured gene
3. Hybridisation protection assay using labelled DNA probes
PCA-3
• PCA-3:PSA mRNA ratio in urine is ‘PCA-3 score’
• PCa-3 score offers specificity to complement sensitive but non-specific serum PSA assay
PCA-3 score
PCA-3 usage
Pros/Cons
• Expensive and relatively labour-intensive (but less so than TRUSS-guided biopsy)
• Sensitivity/specificity paradox
• Patients denied biopsy will still need PSA monitoring
Who needs a PCA-3 test?• Not licensed in UK; has FDA approval
• Manufacturers recommend usage to determine need for second biopsy in patients with raised PSA and first negative biopsy
• No substitute for expert management