EPIC Test Compendium Alpha
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4K PSA Total with Reflex 4K Score

Test Catalog Information

Test Catalog Synonyms

EPIC Synonyms
Cerner Primary Mnemonic4K PSA Total with Reflex 4K Score
EPIC Display Name4K PSA Total with Reflex 4K Score
Allscripts (AEHR) Order Name

Not Orderable

Sunrise Clinical Manager (SCM) Order Name

Not Orderable

EPIC Inpatient Orderable Yes
EPIC Outpatient Orderable Yes
Cerner Results 4K % Free PSA
4K PSA rflx >3.0
4K Score
4K Free PSA
Clinical Info

 High Grade (Gleason 7+) Prostate Cancer Risk Evaluation The 4K score should only be ordered when medically reasonable for consideration of biopsy after excluding benign    cause of PSA elevation.   Limitation an Exclusions for the 4Kscore Do not use this test for a patient:   1) With a previous diagnosis of prostate cancer   2) That has received a DRE in a previous 96 hours (4Days) before phlebotomy. A DRE performed    after phlebotomy is acceptable.   3) That has received within the previous six (6) months 5-alpha reductase inhibitor such as (5-ARI) therapy such an Avedaart(R) (dutasteride) or Proscar (R) (finasteride).   4)  That has undergone within the previous six (6) months any procedure or therapy to treat symptomatic BPH or any invasive, urologic procedure that many be associated with a secondary PSA elevation prior to phlebotomy.   5)  Test is limited to patients age 45 and over.           The 4Kscore Test will not be performed with a positive biopsy result

Specimen Type

Blood

Container

Serum Seperator Tube

Collection Instructions

Container/Tube: Gold top tube Specimen: 3 mL serum Transport Temperature: Refrigerated- If longer then 24 hours please freeze sample.     Specimen is also acceptable if aliquoted & frozen   Note: 1. Please indicate if the patient has a previous biopsy        [] No prior biopsy      []  Negative biopsy     [] Positive biopsy   2.   DRE Results      [ ] Nodule  [ ] Normal  [ ] Not Performed 3. Clinical Indication for ordering 4KScore Test:      Selecting a value below confirms that the patient has two or more elevated PSA results within the past two years.        [  ]  45- 54 years old and total PSA >=2 ng/mL    [  ]  55 -75 years old and total PSA >=3 ng/mL    [  ]  >= 76 years old and total PSA >=4 ng/mL      

Transport Instructions

Refrigerated- If longer then 24 hours please freeze sample.

Specimen Stability

24 hours Refrigerated  7 days Frozen

Methodology

Electrochemiluminescene Immunoassay

Days Performed

TAT: 4-5 Days

Performing Laboratory

BioReference Laboratories-GenPath

CPT

84153 84154

PDM

1859233

Desired Epic Build 4K PSA Total with Reflex 4K Score

Cerner Primary Mnemonic: 4K PSA Total with Reflex 4K Score
PDM 1859233
Informatics - WorkgroupMolecular-send outs
Synonyms *
Display Name *4K PSA Total with Reflex 4K Score
Order Entry Specimen Sources *
Order Entry Specimen Types
Blood
Specimen Navigator Specimen Types
Specimen Navigator Specimen Sources
Specimen Navigator Short Name
Ordering info (EPIC SmartText) High Grade (Gleason 7+) Prostate Cancer Risk Evaluation The 4K score should only be ordered when medically reasonable for consideration of biopsy after excluding benign    cause of PSA elevation.   Limitation an Exclusions for the 4Kscore Do not use this test for a patient:   1) With a previous diagnosis of prostate cancer   2) That has received a DRE in a previous 96 hours (4Days) before phlebotomy. A DRE performed    after phlebotomy is acceptable.   3) That has received within the previous six (6) months 5-alpha reductase inhibitor such as (5-ARI) therapy such an Avedaart(R) (dutasteride) or Proscar (R) (finasteride).   4)  That has undergone within the previous six (6) months any procedure or therapy to treat symptomatic BPH or any invasive, urologic procedure that many be associated with a secondary PSA elevation prior to phlebotomy.   5)  Test is limited to patients age 45 and over.           The 4Kscore Test will not be performed with a positive biopsy result
IP Orderable Yes
OP Orderable Yes
AOEs *

AOE PDMAOE DisplayAOE DescriptionPrompt
17598331 Prior Bx Hx What is the patient's prior Biopsy History X
17598332 DRE Results What was the patient's DRE Results X
17598333 Patient Hx Patient History (select all that apply) X
17598334 Patient Hx Other Patient History Other X
17598335 4K Test discussed 4K test order discussed with patient X
AP AOEs
Special History No
Build Comments
Filter *genetics
Procedure Category Change
Cerner Results

Result DescResult displayResult PDM
4K % Free PSA 4K % Free PSA 1859233C
4K PSA rflx >3.0 4K PSA rflx >3.0 1859233A
4K Score 4K Score 1759833A
4K Free PSA 4K Free PSA 1859233B

Actual Epic build

Procedure Id 114900
Pdm 1859233
Order Display Name 4K PSA Total with Reflex 4K Score
Procedure Name 4K PSA TOTAL WITH REFLEX 4K SCORE
Procedure Master Number LAB11268
Short Procedure Name 4K PSA TOTAL WITH REFLEX 4K SCORE
Category Code 1.0
Category Code Record Name LAB BLOOD ORDERABLES
Synonyms
Clinically Active Yes
Orderable Yes
Performable Yes
Filter Genomics Generic Genomics Procedure
Reference Link Url https://labs.northwell.edu/epic/test/114900
Ordering Instructions
Default Specimen Type Blood
Specimen Type Pick List Blood
Specimen Type List
Op Specimen Type List
Specimen Source Pick List Blood, Arterial Blood, Capillary Blood, Central Line Blood, Venous
Specimen Source Default - Male Blood, Venous
Specimen Source Default - Female Blood, Venous
Specimen Source List
Op Specimen Source List
Ip Lab Test Components For Report
Op Lab Test Components For Report
Order Questions ["3046000032", "3046000031", "3046000030", "3046000029", "3046000028"]
Order Questions Record Name NH IP PRIOR BX HX NH IP DRE RESULTS NH IP PATIENT HX NH IP PATIENT HX OTHER NH IP 4K TEST DISCUSSED
Inpatient Order Questions ["3046000032", "3046000031", "3046000030", "3046000029", "3046000028"]
Inpatient Order Questions Record Name NH IP PRIOR BX HX NH IP DRE RESULTS NH IP PATIENT HX NH IP PATIENT HX OTHER NH IP 4K TEST DISCUSSED
Order Specific Question Override
Inpatient Question Override
Location Restrict List Ip
Location Restrict List Ip Record Name
Location Restrict List Include Ip
Location Restrict List Op
Location Restrict List Op Record Name
Location Restrict List Includes Op
Edp Amb Order Specific Questions Record Name
Edp Ip Order Specific Questions Record Name
Edp Ip Specimen Source Blood, Venous Blood, Central Line Blood, Arterial Blood, Capillary
Edp Op Specimen Source
Edp Ip Specimen Type Blood
Edp Op Specimen Type
Derived Edp Ip Buttons S Blood, Capillary Blood, Venous Blood, Central Line Blood, Arterial
Derived Edp Ip Buttons T Blood
Derived Edp Op Buttons S
Derived Edp Op Buttons T
Ip Orderable 1
Op Orderable 1
EPIC OP AOEs

Question IDQuestion NameQuestionResponse TypeResponse ListRequire Response
3046000028 NH IP 4K TEST DISCUSSED 4K test order discussed with patient Custom List No
Yes
No
3046000029 NH IP PATIENT HX OTHER Patient History Other Free Text Yes
3046000030 NH IP PATIENT HX Patient History Other Custom List Confirmed Abnormal DRE
Confirmed PSA > 3.0 ng ml
Not Provided
Presistant & Significant Rise in PSA
Yes
3046000031 NH IP DRE RESULTS What was the patient's DRE Results Custom List No Nodule
Not Performed
Not Provided
Yes
3046000032 NH IP PRIOR BX HX What is the patient's prior Biopsy History Custom List Not Provided
Yes, Negative
Yes, Positive
Yes
EPIC IP AOEs

Question IDQuestion NameQuestionResponse TypeResponse ListRequire Response
3046000028 NH IP 4K TEST DISCUSSED 4K test order discussed with patient Custom List No
Yes
No
3046000029 NH IP PATIENT HX OTHER Patient History Other Free Text Yes
3046000030 NH IP PATIENT HX Patient History Other Custom List Confirmed Abnormal DRE
Confirmed PSA > 3.0 ng ml
Not Provided
Presistant & Significant Rise in PSA
Yes
3046000031 NH IP DRE RESULTS What was the patient's DRE Results Custom List No Nodule
Not Performed
Not Provided
Yes
3046000032 NH IP PRIOR BX HX What is the patient's prior Biopsy History Custom List Not Provided
Yes, Negative
Yes, Positive
Yes
EPIC Components (results)

Component IDComponent NameBase NameCommon NameExternal NameCerner Result PDM
3047800788.0 4K % FREE PSA 4KFREEPSAPCT 4K % FREE PSA 1859233C
3047800790.0 4K PSA RFLX >3.0 4KPSARFLX3 4K PSA RFLX >3.0 1859233A
3047800791.0 4K SCORE CALCULATION 4KSCORECALC 4K SCORE CALCULATION 1759833A
3047800789.0 4K FREE PSA 4KFREEPSA 4K FREE PSA 1859233B