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Confusion on national PSA testing guidance

By Daniel Cressey

Diagnostic services are being swamped by patients with raised PSA because GPs are not following guidelines on testing, researchers warn.

A survey of 700 GPs has revealed the majority will test any man who requests it and most are unaware of national guidelines which state it is not recommended as a screening tool.

The researchers said those in real need were having their care delayed by inappropriate testing and better dissemination of the guidance was needed.

Study leader Dr Jacqueline McCall, a specialist registrar in public health medicine at the Eastern Heath and Social Services Board in Northern Ireland, said: 'It's causing backlogs in referrals to clinical services. People who have more urgent needs may be delayed. It may also cause harm to patients and anxiety is an issue.

'I'm sure part of it is patient pressure – it's difficult to refuse. There's a need to think about other ways of disseminating the guidelines.'

Two-thirds of GPs in Northern Ireland took part in the survey, which Dr McCall says is likely to be representative of the rest of the UK.

Three-quarters of respond-ents said they would like further information on PSA testing and the survey also found that 9 per cent of GPs actively arrange appointments for tests (BJU International, November).

GPs with only a few years in practice and those with more than 40 years' experience were less likely to test, and male GPs were more likely to arrange a PSA test than women (see graph).

Dr James Kingsland, a GP in Merseyside and member of the scientific advisory group of the Prostate Cancer Risk Management Programme, said: 'It is slightly disappointing when everything has been published showing PSA testing on demand is inappropriate.

'I still think it's storing up long-term problems potentially putting men through unnecessary, harmful procedures.

'Testing an asymptomatic man coming in creates more problems than solving his concerns.'

Dr Paul Roblin, medical secretary of Berkshire, Buckingham-shire and Oxfordshire LMCs, who has developed local guidance on PSA testing, said: 'It's not very easy to find the guidance on PSA. It's a confusing picture which needs clarification.'

Dr Jane Melia, lead research-er at the Institute of Cancer Research's cancer screening evaluation unit, was not surprised by the survey results: 'I would agree there would be considerable variation in GPs' awareness of and use of the guidelines. From our last published work there is a certain amount of screening going on.'

What GPs should know about prostate cancer screening

• Until there is clear evidence to show that a national screening programme brings more benefit than harm, prostate cancer screening should not be offered to asymptomatic men.

• Under the informed choice scheme a man can have a test on request provided that he fully understands the lack of good-quality evidence about the benefits and risks of testing.

• He should be aware that two out of three men with raised PSA level will not have prostate cancer, the PSA test can also

miss prostate cancer, and while a raised PSA level in the blood may indicate cancer, a prostate biopsy is still required to determine if cancer is present.

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