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• Total PSA (tPSA):
o Measures overall PSA levels in the blood.
o Used as the primary screening test.

• Free PSA (fPSA): 
o Measures unbound PSA.
o Lower free PSA percentage suggests a higher cancer risk.

• PSA Density (PSAD): 
o Adjusts PSA levels based on prostate volume
o Helps differentiate BPH from cancer.

• PSA Velocity (PSAV): 
o Tracks PSA level changes over time.
o Rapid increase may indicate aggressive cancer.

• PSA Doubling Time (PSADT): 
o Measures how quickly PSA levels double.
o Faster doubling suggests more aggressive cancer.

• Pro-PSA & Prostate Health Index (PHI): 
o Includes p2PSA, total PSA, & free PSA
o To improve cancer detection & reduce unnecessary biopsies.

• 4Kscore Test: 
o Evaluates four PSA-related proteins along with clinical factors.
o To estimate the risk of high-grade cancer.

• PCA3 Test: 
o Urine-based genetic test detecting PCA3 mRNA.
o Highly specific to prostate cancer.

• IsoPSA Test: 
o Analyzes PSA structural changes to distinguish benign conditions from cancer.

 

 Systemic Inflammatory Response Syndrome (SIRS)

  1. Non-specific (infections vs non-infectious)
  2. ≥2 of the following:
    • Temp >38°C or <36°C
    • HR >90 bpm
    • RR >20 or PaCO₂ <32 mmHg
    • WBC >12,000/mm³, <4,000/mm³, or >10% bands

Sepsis

  1. Organ dysfunction due to dysregulated host response to infection.
  2. SOFA score increases by ≥2.
  3. qSOFA (≥2 indicates high risk):
  • Altered mental status (GCS <15)
  • RR ≥22/min
  • SBP ≤100 mmHg

Severe Sepsis (Obsolete Term in Sepsis-3, 2016)

• Sepsis + tissue hypoperfusion/organ dysfunction.

Septic Shock

• Sepsis + circulatory failure

  • Hypotension requiring vasopressors (MAP <65 mmHg).
  • Lactate >2 mmol/L 

Management (Surviving Sepsis Campaign Guidelines)

  • Early recognition & treatment (within 1 hour)
  • IV fluids (30 mL/kg crystalloid in 1st 3 hours)
  • Broad-spectrum antibiotics ASAP
  • Vasopressors (norepinephrine) if MAP <65 mmHg
  • Source control (drain abscesses, remove infected devices)
  • Supportive care (oxygenation, ventilation, glycemic control, DVT/stress ulcer prophylaxis)


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