UPDATE - Issue 06 - September 2000
Urgent cases to be seen by consultant in two weeks
The consultation process is over. The guidelines on what constitutes an urgent case have been published. The date is set when the new regime starts. So, from December all patients suspected by a GP of possibly having prostate cancer should be seen by a consultant within two weeks. This is something we welcome, particularly as the guidelines have been amended to take account of comments and suggestions made by the Prostate Research Campaign UK.
Now it is up to the hospitals and the NHS Trusts to deliver. But are they able to do so? Are all GPs aware of the new guidelines? They should be, although the volume of paper dropping through their letterboxes makes it quite possible that they will need reminding.
Are there enough consultant urologists? This is a serious issue. Their work load is set to increase not just because of the new guidelines relating to cancer of the prostate but to cancers of the bladder, kidneys and testes as well, for which new guidelines are set to be introduced at exactly the same time. The number of consultants specialising in this field has been roughly constant at 850 for a number of years now. We already know that there are serious shortages in some parts of the country (Wales, for example). So we must question whether the new target will itself be met throughout the country. Furthermore, we wonder whether in meeting the set time for a patient to see a consultant the delays before treatment actually starts will, in the event, increase rather than decrease.
The new guidelines underline the importance of PSA testing. Indeed they are quite meaningless if PSA tests are not to be used. However, a footnote to the guidelines again states the current position regarding screening and states that 'PSA testing of asymptomatic men or screening for prostate cancer is not national policy. It is recommended that a PSA test, except in men clinically suspicious of prostate cancer should only be performed after full counselling and provision of written information.'
THE URGENT REFERRAL GUIDELINES
. An elevated age specific PSA in men with a 10 year life expectancy.
(The age specific upper limit of normal for PSA rises from 2.8 at age
50 to 5.3 at age 70.)
. A high PSA (over 20) in men with a clinically malignant prostate or bone pain.