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Uro-oncology – an Update

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

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Uro-oncology – an Update

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  1. Uro-oncology – an Update Kieran Jefferson Consultant Urological Surgeon UHCW

  2. BMI Meriden Hospital

  3. 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

  4. Warwickshire one-stop haematuria clinic • Clinical assessment by Consultant Urological Surgeon • Blood and urine sampling • Renal tract USS + CT Urogram (frank haematuria) • Flexible cystoscopy and discussion of results

  5. 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

  6. 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

  7. PCA-3

  8. PCA-3 assay • Bead capture of mRNA • Amplification of captured gene • Hybridisation protection assay using labelled DNA probes

  9. 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

  10. PCA-3 score

  11. PCA-3 usage

  12. Expensive and relatively labour-intensive (but less so than TRUSS-guided biopsy) Sensitivity/specificity paradox Patients denied biopsy will still need PSA monitoring Pros/Cons

  13. 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 Who needs a PCA-3 test?

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