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At the heart of general practice since 1960

Rift with computer firm not healed

GPs are being urged to

boycott the Government's screening-on-demand policy for prostate cancer after US research found the PSA test was 'useless' for predicting cancer.

The authors declared the PSA era 'over' after their 20-year study of tissue samples found PSA testing could do little more than indicate the size of a man's prostate.

One of the Government's own advisers on prostate cancer called for GPs to stand firm against patient requests for a PSA test and said digital rectal examination should be the diagnostic test of choice for symptomatic patients.

Dr James Kingsland, member of the scientific reference group that advises the prostate cancer risk management programme and a GP in Wallasey, Liverpool, said: 'PSA should not be used as a screening test but unfortunately because of patient demand it's being done. It's ill-informed and unfair to the patient but sometimes it's too easy to agree.

'You shouldn't be giving any test just because a patient demands it, just as you should not give antibiotics just because people ask for them.'

Study author Professor Thomas Stamey, professor of urology at Stanford University School of Medicine, said: 'All men get prostate cancer if they live long enough. All you need is an excuse to biopsy the prostate and you are going to find cancer.'

His study, published in the Journal of Urology (September), compared PSA levels with records of tumour grade and prostate volume in 1,317 radical prostatectomies.

It found PSA levels were related to prostate volume but not tumour stage and concluded yearly digital examinations for men over 50 were the best way to detect cancer.

But despite mounting evidence of the inaccuracy of the PSA test, its use as an opportunistic screening tool is growing dramatically in the UK (see Pulse, July 12).

GPs said they were continuing to conduct PSA tests when patients asked for them, but only after going through the lengthy process of explaining the implications.

And the National Cancer Screening Programmes emphasised the importance of providing clear and balanced information for patients so they could make an informed choice on whether to take the test.

By Emma Wilkinson

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