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Patients age 45 should be able to request PSA test, say new guidelines

Men at higher risk of prostate cancer should be able to have a PSA test when they reach the age of 45, according to new consensus statements.

The recommendations, compiled by Prostate Cancer UK from a survey of over 300 health professionals, say that all men should be able to have a PSA test over the age of 50.

Higher risk men – including black men and those with a family history of prostate cancer – should be able to request the test once they reach the age of 45, even if they are asymptomatic, it says.

The statements adds that GPs should also be prepared to open discussion with these high-risk men about the pros and cons of the PSA test, and that men over 40 who have no symptoms of a prostate problem should think about having a PSA test to help work out their risk of getting prostate cancer later in life.

Current guidelines from Public Health England only recommend PSA testing for men over 50 years, providing they have opened the discussion during an appointment with their GP. PHE advise GPs not to proactively raise the issue with this patient group.

The Prostate Cancer UK recommendations consist of 13 statements in total, and are designed to support ‘primary healthcare professionals to use the PSA test more effectively for men without symptoms of prostate cancer’.

Dr Jon Rees, a GPSI in urology in Somerset and chair of the Primary Care Urology Society, said: ‘These consensus statements offer us some much needed support and guidelines. We consistently fail to make decisions on whether to test or whether to refer for prostate biopsy that are based on an individualised assessment of risk, relying instead on the PSA “normal range” alone.

’But prostate cancer risk factors are the greatest weapon we have. These statements make a strong case for better risk assessment in primary care, and hopefully better targeting of high risk men, while at the same time reducing unnecessary interventions for those at low risk.’

Heather Blake, director of support and influencing at Prostate Cancer UK added: ‘GPs must act to make sure that the PSA test becomes our best means of achieving early detection of prostate cancer in men without symptoms, especially those at higher than average risk.’

The guidance also states that GPs should advise men against having the PSA test if they are asymptomatic and likely to live for less than ten years.

Please note, the original headline said GPs should offer PSA tests to patients aged 45. This was incorrect - the guidelines say patients should be able to request the tests, not that GPs should offer them. The article was changed at 11:30 on 30 March 2016.


Readers' comments (16)

  • So this is a charity led guideline, based on experience of GPs alone, with no actual evidence basis for their recommendations, and an inherent bias given their funding model and emotive approach to managing a complex and controversial topic. The statements aren't helpful, they're woolly at best, and rely on a gold standard patient who is able to interpret complex evidence and consider all potential outcomes impartially, which when it comes to making personal health decisions, is nigh on impossible, particularly when powerful and vocal charities like this present such imbalanced evidences.

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  • asymptomatic PSA testing has a NNT of about 1 in 1050 or so.

    why is prostate cancer UK advocating a non evidenced based approach to this? it seems charities have a wayward agenda these days to highlight their own cause.

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  • This is not new advice.

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  • This is not Guidance. This is an interested body sounding off about a survey for crying out loud.

    What next? Nestlé giving guidance on chocolate consumption in obesity?

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  • Tony Gu, do you happen to know the number needed to harm in that cohort? If you haven't already, Margaret McCartney's book the Patient Paradox has a fantastic section on both charities influence on guidelines, and also a good section on the dearth of evidence for PSA screening.

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  • Vinci Ho

    The way I see this is probably in three folds:
    (1) It is probably right to say we need a threshold age to begin a screening programme, like breast and bowel cancers.
    (2) A so called 'better' test than PSA has been an outcry for too long. It seems there is limitation somewhere .All sorts had been mentioned but did not really materialise in reality . Then you come up with a relatively cumbersome scoring system(s) understandably. Remember consultation time is also limited.
    (3) More important to me is the final definitive procedure to obtain samples for histology . The arguments in (2) will favour a more proactive approach if by any stretch of imagination , the risks and side effects of prostate biopsy can be substantially reduced by any means . Focus on research should be re-adjusted......

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  • From their website:

    'Usually, experts look at the results of medical research to help them produce guidelines. But there haven’t been enough studies about the PSA test to give us all the answers. So until more results from research are available, we needed to get agreement from a large group of health professionals in order to write guidelines to fill some of the gaps. We asked more than 300 health professionals to tell us whether they agreed or disagreed with each guideline. We then made changes to the guidelines until the majority of the health professionals agreed with them. A smaller group of experts then met to talk about the guidelines and helped us produce the final version.'

    Not exactly grade A evidence is it!

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  • I'll tell you what PCUK, if you believe in it so much;
    - Fund a randomised control trial of sufficient size and quality to evidence your suggestion.
    - Have a science-based discussion with the national screening bodies about how this might work.
    - Have a realistic discussion about what it will cost, the benefits and harms, and who will do the work - and how you'll fund that.

    In the absence of the above, if you resort to poor evidence and media-hype, expect us to tell you to PCUK off.

    National screening and immunisation tasks should not be the GPs remit - not to monitor, not to recall, not to invite, not to manage or cajole or any such tripe. If you want us involved, pay us per activity at a rate we'll negotiate through someone who doesn't wear a cardie (ie not the BMA), and manage the BS yourself. This INCLUDES flu jabs, pneumo, child imms etc.

    You find them. You call them. You pay us.
    Or you can PCUK off as well.
    Otherwise we wear all the costs and they slash all the profits.

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  • Is there any evidence that detecting prostate cancer early improves outcomes and quality of life? My understanding is it may keep cancer more localised but there in no change to mortality and probably reduces quality of life from time of diagnosis significantly. If not then why do this?

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  • NNI about 1400
    NNH about 50
    NNT it is a test not a treatment
    This British PSA is a unique test on a world basis,the patient chooses it not the doctor though the patient cannot sign for it the doctor has to,the doctor has a duty of care the DOH doesn't,though the DOH says the patient has a right to it even if the doctor feels it is overall harmful
    Thus signing for a harmful test on a national basis,note the stunning silence from the GMC
    The patient has a right to the test though the guidelines say nothing about a right to have it interpreted,probably because it is too misleading and inaccurate to be sensibly interpreted
    The guidelines say the patient can ask for it but the doctor should not initiate the conversation
    The national screening assesment body have not initiated a UK program quite sensibly hence this apalling fudge

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