Increased Patient Demand for Prostate Test Has Serious Implications for Cancer Services

Armen Hareyan's picture
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PSA tests for prostate cancer

Male patients are increasingly demanding PSA tests for prostate cancer, despite lack of evidence that they are effective, according to a survey of more than 700 family doctors published in the November issue of the urology journal BJU International.

Researchers from Queen's University Belfast and the Eastern Health and Social Services Board discovered that more than two-thirds of doctors (65 per cent) said that they provided PSA tests on request.

They did this despite the fact that the UK National Health Service Executive and the UK's National Screening Committee don't recommend routine screening for prostate cancer, in the absence of symptoms, using PSA (Prostate Specific Antigen) blood tests.

"Increased on-demand PSA testing represents a major pressure on family doctors and has serious implications for prostate cancer investigation and treatment" says co-author Dr Jackie McCall, Specialist Registrar in Public Health Medicine at the Eastern Health and Social Services Board.

"Clinical evidence suggests that PSA testing may not improve survival or quality of life and might cause more harm than good, to patients and services alike."

The team surveyed all 1067 family doctor practices in Northern Ireland and matched their responses with a regional PSA testing database.

More than two-thirds of the doctors surveyed (704) responded to the postal questionnaire, which explored their personal profile, the profile of their practice and their PSA testing behaviour.

A detailed analysis of the results revealed that there were a range of complex factors that influenced whether family doctors carried out PSA screening. These included:

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    49 per cent of doctors were aware of the national guidelines for PSA testing, but that awareness did not influence testing levels.

  • Tests were more likely to be ordered by full-time male doctors who had been practising for 21 to 30 years and by those who worked in rural practices.

  • 13 per cent of doctors had held a postgraduate post in urology, but this did not affect their testing behaviour. And working in an accredited training practice was associated with lower testing levels.

  • Opportunistic PSA testing is being carried out on men who consult their family doctor about unrelated complaints. 47 per cent of doctors reported that PSA testing had previously picked up prostate cancer in patients with no symptoms and 51 per cent said this influenced their practice.

  • Doctors were also more likely to test men with a positive family history of prostate cancer.

  • Only half a per cent of the doctors surveyed reported a specialist interest in male health, despite prostate cancer being the commonest male cancer and current drives to improve awareness of the disease in primary care.

Data from all the first PSA tests ordered by doctors during the survey period (2003-2004) were matched with the questionnaire responses and analysed to investigate their association with variables such as gender, age, location of practice and awareness of guidelines.

Prostate Cancer PSA Tests

More than 15,000 PSA tests had been ordered

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