Blog entry by Rcgp Learning

%C2%A3iStock-155146213.jpgProstate cancer is the most common cancer in men, with around 47,000 men diagnosed each year in the UK (1), causing 11,287 deaths in 2014 (2). March is Prostate Cancer Awareness Month, organised by Prostate Cancer UK, and with various prostate cancer events taking place throughout the month, you may find that more patients want to ask about PSA testing and whether they can have the test.

As GP referral is the route with the highest proportion of cases diagnosed at an early stage for prostate cancer, PSA testing in primary care is an important part of the diagnostic chain. The pros and cons of PSA testing in asymptomatic men has been passionately discussed over the years though there is evidence that in some patients it can pick up prostate cancer before symptoms appear and can even identify fast-growing cancers at an early stage.

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The Prostate Cancer Risk Management Programme (PCRMP) was reviewed in 2016 to better inform GPs on the best approach. Based on the PCRMP guidelines (1) and suggestions from Prostate Cancer UK (2)(3), here are some key points to take away:

• Any man in the UK aged 50 and over who asks for a PSA test and carefully considers the implications with their GP is should be tested
• Those considered ‘high risk’ for prostate cancer are aged 50 or over, men with a family history of the disease and black men
• The PCRMP guidelines apply when discussing the test with asymptomatic men aged 50 and over who proactively ask about it, not high risk men or men of any age who have symptoms
• GPs should consider offering a digital rectal examination (DRE) to all asymptomatic men who have decided to have a PSA test
• The new recommended prostate biopsy referral value for men aged 50-69 has changed to ≥3.0ng/ml
• The PSA test can miss about 15% of cancers
• All men have the option to be re-tested in the future if their PSA test result is ‘normal’


If you would like to read more about PSA testing and the guidelines around it, here are some resources that may be useful for yourself and your patients:

PCRMP Pack – Further reading on the revised PCRMP guidelines from PHE
PSA Resource Pack – Expert information for healthcare professionals from Prostate Cancer UK
Best Practice Case Studies – A selection of case studies you could apply to your practice from Prostate Cancer UK
The Tool kit – A resource to help men who have been diagnosed with prostate cancer from Prostate Cancer UK
NHS decision aid – An online tool to help men decide whether to have the PSA test from the NHS


In addition to the resources above, you can also find a selection of eLearning materials from the RCGP. Our Prostate Cancer: Early diagnosis in General Practice course is FREE to all healthcare professionals and counts towards your CPD hours. If you’re an RCGP member, you can also access the following courses:

EKU14: Prostate Cancer: Diagnosis & Treatment

EKU16 Briefing: Screening and prostate cancer mortality

References:

(1) Public Health England. Prostate specific antigen testing: summary guidance for GPs [Internet]. Available from: https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation

(2) Cancer Research UK. Prostate cancer mortality statistics. [Internet]. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/mortality

(3) Prostate Cancer UK. Prostate Cancer UK policy position on the PSA test [Internet]. Available from: http://prostatecanceruk.org/media/2493257/prostate-cancer-uk-policy-position-on-the-psa-test-2016.pdf

[ Modified: Tuesday, 18 April 2017, 2:51 PM ]