Abstract
BackgroundWorldwide, the use of prostate specific antigen (PSA) testing as a screen for prostate cancer is contentious. Whilst there is no National UK Screening programme, many men undergo opportunistic screening. This study investigates UK urologist's usage of PSA and the awareness surrounding the Department of Health (DoH) PSA guidelines.MethodsUrologists were sent a questionnaire regarding PSA cut-off values.ResultsOf the 733 urologists eligible to participate in this study 346 returned completed questionnaires giving a response rate of 47%. The most commonly generally used age-related PSA cut-off values (36% of respondents) are – 3.5 ng/ml for 50 – 59 year olds, 4.5 ng/ml for 60 – 69 year olds and 6.5 ng/ml for over 70 year olds. Two-thirds (58%, 200/346) of respondents were aware of the DoH PSA guidelines but only 20% (n = 69/346) follow these guidelines. The majority of respondents (68%, n = 234/346) used higher PSA cut-offs than recommended by the DoH. The level of compliance showed marked regional variation with a range from 7% to 44% (median 19%). In addition, it was apparent that lower PSA cut-off values were used in private practice as opposed to the National Health Service.ConclusionA nationwide lack of agreement on PSA cut-off values may generate a variable standard of care both regionally and in NHS versus private practice. Generally, higher PSA cut-off values are being used than recommended by the DoH guidance.
Highlights
Worldwide, the use of prostate specific antigen (PSA) testing as a screen for prostate cancer is contentious
Age-matched PSA cut-off values for NHS versus private practice were compared, showing 20% (68/344) vs 26% (38/144), respectively, of urologists using the DoH PSA guidelines. When this was further investigated it was clear that most respondents, in both NHS and private practice, were using values higher than those recommended by the Department of Health (Figure 1)
The principal finding of this study is that, in the United Kingdom (UK), there is a widespread variation in the application of PSA cut-off values among urologists, which may be leading to an inequality in men's healthcare related to PSA testing
Summary
The use of prostate specific antigen (PSA) testing as a screen for prostate cancer is contentious. At present opportunistic screening is occurring, with many physicians using the serum Prostate-Specific Antigen (PSA) test. It is possible to detect PSA in small amounts in the serum of healthy males and this level increases in prostate cancer [3]. Whilst PSA is tissue specific an increase in circulating levels is not definitively linked to tumour development. Urinary infection, prostatitis, urinary retention, ejaculation and benign prostatic hypertrophy all raise serum PSA levels [3]. The PSA serum test was initially used as a sign of recurrent disease following radical prostatectomy or radiotherapy for prostate cancer, but came into mainstream usage as an diagnostic test in the 1980s [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
