Perception of Abnormal Serum Prostate-Specific Antigen (PSA) Test Results amongst Family Practitioners

Abstract

INTRODUCTION With increased use of serum prostate-specific antigen (PSA) testing, prostate cancers are diagnosed at an earlier stage in younger men, when radical curative treatments are appropriate. Modifications of the PSA test such as PSA velocity and age-adjusted values are available to aid in the selection of patients for biopsy. However, it is not clear whether these data are used in general practice. PATIENTS AND METHODS A self-administered questionnaire was mailed to all primary care practices within one region in the UK. A series of visual analogue questions designed to identify referral thresholds for age-adjusted PSA levels and PSA velocity were used to identify patterns in referral behaviour. RESULTS Individual family practitioners see only small numbers of patients requesting PSA tests or with newly diagnosed prostate cancer each year. The median (range) thresholds considered for referral at ages 45, 55, 65, 75 and 85 years were 4.5 ng/ml (2.5–15.5 ng/ml), 5.5 ng/ml (3.0–15.5 ng/ml), 6.5 ng/ml (3.5–15.5 ng/ml), 6.5 ng/ml (3.5–25.5 ng/ml), and 7.5 ng/ml (3.5–25.5 ng/ml), respectively. Only 5% of practitioners correctly identified the age-specific PSA threshold for referral of a 45-year-old man. CONCLUSIONS It is important to remember that younger men (even those in their forties and fifties) may be at risk of prostate cancer even if asymptomatic. It is important in a climate of increasing demand for PSA testing that those who initiate the process understand the implications and limitations of testing, including appropriate triggers for referral to secondary care. The exact approach required for the successful dissemination of this information to primary care is not clear, but our data suggest that a better understanding is required.

Evaluating the Use of Prostate-Specific Antigen as an Instrument for Early Detection of Prostate Cancer beyond Urologists: Results of a Representative Cross-Sectional Questionnaire Study of General Practitioners and Internal Specialists

“…While urologists are expected to act consistently with the German S3 guideline and findings of the recent literature in order to ensure their expertise [1,2,3,4,5,6], this cannot be deduced for GPs and ISs by implication. On the other hand, international studies show that PSA-based early PCa detection is widely used by GPs and ISs [7,8,9,10,14,15,16,17,18,19,20]. Furthermore, there is no scientific evidence on which consequences are drawn by GPs and ISs based upon given PSA levels in combination with clinical findings.…”

“…Furthermore, there is no scientific evidence on which consequences are drawn by GPs and ISs based upon given PSA levels in combination with clinical findings. Available study data on this topic illustrate the heterogeneous role of GPs in population-based PSA screening for PCa in various countries [7,8,9,10,14,15,16,17,18,19,20]. A recently published study by van der Meer et al [21], exploring the impact of ERSPC results on the implementation of population-based PCa screening by GPs in daily routine, clearly showed the consequences in the region of Rotterdam: (a) after publication of the ERSPC data, fewer PSA tests were performed by GPs in men ≥60 years of age; (b) PSA levels of 4-10 ng/ml were controlled significantly less frequently; (c) significantly fewer patients with a PSA level >4 ng/ml were referred to a board-certified urologist.…”

Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review

“…Fourteen articles met our inclusion criteria. Screening the reference list of these articles revealed one additional study meeting the inclusion criteria (Figure 1) [6,7,14-26]. …”

“…In the UK, referral rates were 86% and 30% in 1995 and 2008, respectively (all GPs) [22,23]. Cut off values for referral were reported in 4 studies and varied between a mean of 5 ng/ml to 13 ng/ml for patients aged 70–84 years old (Table 4) [6,7,23,26]. …”

General practitioner perception of prostate-specific antigen testing has improved, but more awareness of prostate cancer risk in younger patients is still awaited

“…In 2006 a survey of general practitioners (GPs) throughout Suffolk, in England, showed a particular reluctance to refer younger men with abnormal PSA levels. 11 It is logical, that younger men have the most to gain from early diagnosis and curative treatment. Indeed, the latest evidence suggests a particular advantage to curative surgical therapy in younger men and those with high-risk disease.…”