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

Colorectal cancer screening in Australia

Colorectal cancer screening

1. Colorectal cancer screening is currently recommended for asymptomatic and average risk individuals at the age of 50 or above every 2 yearly until the age of 74 with repeated negative findings. 
2. NBCSP is still at the rolling out stage, it will be completed by 2020.
3. Colorectal cancer has a good 5 year survival rate if it is detected early (stage A 90% and stage B 70%)
4. NBCSP uses immunochemical testing and it does not require any dietary or medication restriction. 
5. NBCSP FOBT does not pick up upper GI bleed. 
6. The screening strategy for asymptomatic individuals depend on their risk level. 
7. 
8. A positive FOBT does not mean that the person has cancer. The risk of colorectal cancer from a positive FOBT test is around 5%.
9. Try to use every opportunity you have to promote cancer screening. 
10. History and examination is still important in cancer screening program.