MSRA High-Yield Revision Guide: Prostate Disorders, PSA Simplified
- examiner mla
- Jul 7, 2025
- 1 min read
✅ 1. Prostate Disorders & PSA – Key Exam Points
When to suspect prostate cancer (2WW referral):
Unexplained bone/back pain (think metastases)
Weight loss, anorexia, lethargy
Hard/nodular prostate on DRE
Obstructive LUTS + red flags
PSA ≥ 3 ng/mL (age 50-69) or rising trend at any age
✔️ Normal PSA does NOT rule out cancer if red flags are present.
PSA alterations:
↑ PSA: ejaculation, cycling, DRE, UTI/prostatitis, biopsy/catheterisation
↓ PSA: finasteride/dutasteride (reduce by ~50%; multiply by 2 for true value)
Management summary:
Condition | DRE | PSA | Treatment |
BPH | Smooth, enlarged | Normal/slight ↑ | α-blocker ± 5-ARI |
Prostate cancer | Hard, nodular | Normal → very high | 2WW referral → staging |
Chronic prostatitis | Smooth, tender | Normal | Long-course trimethoprim or doxycycline + NSAID + CBT |
Acute prostatitis | Boggy, tender | ↑ | Urgent antibiotics ± admission |
✔️ CBT in chronic prostatitis targets pain coping, pelvic floor relaxation, and health anxiety.
✅ 2. LUTS Decision Shortcuts
LUTS + bone pain or weight loss or hard prostate = Cancer → urgent referral.
PSA < 3 + red flags → Cancer not excluded.
Chronic perineal pain + normal PSA + tender prostate → Chronic prostatitis → long-course antibiotics.
✅ 3. Pharmacology High-Yield MOA Summary
Drug | MOA |
Finasteride | 5-alpha reductase inhibitor → ↓ DHT → ↓ prostate size |
Alpha-blockers (tamsulosin, doxazosin) | α1-adrenergic blockers → relax prostate/bladder neck smooth muscle |
✔️ Finasteride takes months to work, alpha-blockers act within days.
✅ 4. Screening Programme Pearl
Prostate Cancer: No national screening; PCRMP (Prostate Cancer Risk Management Programme) guides PSA testing after informed discussion.
📚 References:
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