GP prostate screening ruled out but practices told to give PSA tests on request

Public Health England (PHE) has ruled out systematic screening of men over 50 with PSA tests, but has advised GPs to provide the test to asymptomatic patients who request it.

PSA tests are the recommended method of detecting localised prostate cancer – and evidence shows use of the test could help reduce prostate-related mortality by 21%, PHE said in updated guidance.

But the test has been deemed ‘not accurate enough’ to form part of a national screening programme, as the majority of patients with positive results either do not have cancer or have a slow-growing cancer that does not cause symptoms or shorten life.

GPs are urged to use their clinical judgment to offer the test to patients exhibiting possible symptoms of prostate cancer.

They are advised not to proactively raise the issue of PSA testing in asymptomatic men.

But any asymptomatic patients over 50 who ask for a test should be offered one – only after being given a 'full and balanced view of potential harms and benefits’ of doing so, the guidance adds.

Patients with a raised PSA level – a value of 3.0ng/ml or higher – should be referred on to a specialist for further tests. An estimated 17% of men tested have an abnormal result.

Prostate cancer

Further tests are needed to confirm a diagnosis, as low specificity of the test means it is 'not diagnostic' and around three in four men with a raised PSA level will not have cancer.

These can include digital rectal examinations (DREs) and prostate biopsies.

The test will also miss about 15% of cancers, and patients with low PSA levels could still be referred if there are other concerns.

Prostate cancer is the most common cancer in men in the UK and around 47,000 are diagnosed each year, contributing to around 11,000 deaths. Diagnosis is most common between the ages of 65 and 69.

By the age of 80, around 80% of men will have evidence of cancer cells in their prostate.

Those with a family history of the disease and overweight/obese patients have a higher risk of developing the disease. Men of black ethnic origin have a lifetime risk twice as high as white men, with a risk of one in four compared to one in eight.

PHE director of screening Dr Anne Mackie said: ‘The decision about whether a man takes a PSA test is a complex one and has to be thought through carefully.

‘There are potential harms as well as benefits in taking the test and we know that many men really appreciate the opportunity to discuss the test with their GP.

‘Our new information pack will make it easier for GPs to have this conversation with their patients, and assist men in making a decision that is right for them.’

Photo: iStock

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