Prostate guide fails to increase referrals

A lack of confidence in PSA tests is blamed for low referral rate from GPs to urologists.

The introduction of the NHS Prostate Cancer Risk Management Programme (PCRMP) has failed to have a significant impact on the number of men being referred for prostate cancer, UK research suggests.

Doubts over the accuracy of PSA testing and a lack of awareness of the programme among GPs appears to be hindering the number of GP referrals to urologists.

Only 56 per cent of the 200 GPs questioned were aware of the PCRMP, despite a copy being sent to all GPs and urologists in England as part of NHS cancer screening initiatives.

Introduced in November 2002, the PCRMP was designed to guide GPs on age-specific PSA cut-off levels in asymptomatic men.

However, the survey carried out in 2004 showed that while 2,494 PSA tests were taken in the two years before the PCRMP launch, this only increased to 3,209 PSA tests in the two years after guidance was introduced.

Additionally, the number of men referred to a urologist by their GP increased from 14 per cent to just 18 per cent after introduction of the PCRMP.

Lead researcher Dr Jane Melia, from the Institute of Cancer Research in Surrey, said: 'The findings show that GPs are unsure about how to handle PSA test results.

'GPs are being cautious and are choosing to retest patients rather than rushing them to urologists.'

Professor Roger Kirby, from the London Prostate Cancer Centre, said: 'I am not surprised that the PCRMP has failed to have an impact on the number of referrals.

'GPs are concerned about the accuracy of PSA tests. We need a replacement test for PSA if we are to pick up more cases of prostate cancer.'

It was inevitable that some GPs will be unaware of the PCRMP. They were sent so many different guidelines that it could be difficult to read them all, added Professor Kirby.

The PCRMP is currently being reviewed.

Br J Cancer Online 2008

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