PSA Testing

PSA testing

PSA. 3 letters which give many GPs headaches. Men often come in requesting for PSA. The current stand by the college of GP from the Guidelines for preventive activities in general practice:

"Routine screening for prostate cancer with DRE, PSA or transabdominal ultrasound is not recommended.548-550 DRE has poor ability to detect prostate disease.551 Yet some cancers missed by PSA testing alone are detected by DRE,551 which is why those recommending screening advocate DRE as well as PSA."

"GPs need not raise this issue, but if men ask about prostate screening they need to be fully informed of the potential benefits, risks and uncertainties of prostate cancer testing.556When a patient chooses screening, both PSA and DRE should be performed."

It is a difficult topic to educate people on. Sometimes even doctors struggle to understand the statistics presented.

If the patient has already had PSA done in the past, I will just repeat them when they request for it. If they have never had it done before, I will try my best to explain the implication of having a PSA test. There are many resources out there which you can use to explain PSA test.

PSA decision card

PSA info graphic

My feeling is that this information is used in discourage people from having the test done. I don't think I have met any of my patients who actually understand the implication of the test. They often ask me after a good 10 minutes discussion, so "should I have it done?". But for the exam, we need to have a prepared approach in PSA testing, and make sure you take the college's stance.


References:
1. http://www.racgp.org.au/your-practice/guidelines/redbook/early-detection-of-cancers/prostate-cancer/
2. http://www.cancer.gov/types/prostate/psa-fact-sheet
3. http://www.usanz.org.au/uploads/65337/ufiles/PDF/6_PSA_decision_card_041007.pdf