There has been a LOT of media interest in PSA testing in the past few weeks since Stephen Fry and Bill Turnbull ‘went public’ about their prostate cancer. It is very important to be aware that the evidence around testing has however not changed.There is no screening programme for prostate cancer because it does not meet essential criteria. It is neither 100% specific or sensitive. We should not be actively talking about PSA screening unless men are symptomatic or specifically ask about it.
Prostate cancer is the commonest cancer in men. About 1 in 8 white men will get it in their lifetime, which is similar to the risk of breast cancer in women. However, only about 1 in 25 will die from it. So, more men die with prostate cancer than of it.
There is a risk management programme, and men are entitled to ask for a PSA test if they have made an informed decision. A rectal examination should always be used in combination with PSA testing.
When we are talking about screening for prostate cancer, we are talking about ASYMPTOMATIC MEN.
Symptomatic men with lower urinary tract symptoms may need a PSA test as part of their clinical work up, but should still be fully informed about the pros and cons of testing.
PSA Age-specific cut offs should be (ng/ml): a level higher than this is abnormal
40–49 y: ≥2.
50–69 y: ≥3
70 y or older: ≥5.
(Based on the latest National Screening Committee Prostate Cancer Risk Management Programme, although older NICE CKS says ≥4 for those aged 60–69y).
- Requests made to staff for PSDA testing based on health anxiety or a 'wish for screening' in asymptomatic patients should be given the appended DOH leaflet if over the age of 50 years to read and consider if they want to proceed to testing or not-anyone under that age the request should be forwarded as a task to the usual GP
- Patients having agreed to the PSA test as an informed choice will need to see a GP for a rectal examination as well -we cannot offer the PSA test without a DRE being agreed to.
- If a patient is symptomatic and requesting the PSA test they should be booked in with a GP or ANP and any testing can be done after assessment
Before having a PSA test, men should not have:
- an active urinary infection (PSA may remain raised for many months)
- ejaculated in the previous 48 hours
- exercised vigorously in the previous 48 hours
- had a prostate biopsy in the previous 6 weeks
- PSA is stable in whole blood for up to 16 hours at room temperature. When taking blood you should ensure that the specimen will reach the laboratory and be separated within this time frame.
DOH patient leaflet on PSA pros and cons see below