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Advisers say PSA policy is 'bad medicine'

GP advisers have accused the Government of putting GPs in an impossible position by jumping the gun on prostate specific antigen testing.

They say the policy that requires GPs to provide PSA tests on demand should be abandoned until full results from the landmark ProtecT trial are reported in 2006.

Latest results from 8,823 men aged 50-69 from 18 practices in the ProtecT pilot study show 10 per cent had raised PSA levels.

All underwent biopsies, which revealed that just 26 per cent had prostate cancer ­ with 80 per cent of cases clinically localised, according to data published on the Department of Health website.

Study co-author Dr David Jewell, a part-time GP and editor of the British Journal of General Practice, condemned the current policy as 'bad medicine'.

He said the department was wrong to bow to the demands of patients and special interest groups and order GPs to give the PSA test to any man who requests it.

'They gave in to pressure and as a result the advice is inconsistent and misleading,' said Dr Jewell, senior lecturer in primary care at the University of Bristol. No one knew how to interpret the results of a PSA test and men should not be tested, he added.

Dr Graham Hornett, a member of the Government advisory group whose recommendation against PSA testing was overruled by ministers, said the test-on-demand policy left GPs in a 'very difficult position'. It was inevitable GPs would send significant numbers of men for invasive biopsies that were unnecessary.

Dr Hornett, a GP in Wonersh, Surrey, added: 'Until further research has been done there is no justification for PSA testing.'

He said the fact so many cases of prostate cancer would never cause symptoms in the man's lifetime meant it was unclear whether watchful waiting or active treatment was best even when a case was diagnosed.

Dr Hornett urged GPs to repeat the PSA test in any asymptomatic patient whose level was only just above the 3ng/ml threshold set by the Government for further investigations in patients aged 50 to 59 and 4ng/ml in patients aged 60 to 69.

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