Department of Health changes stance on PSA

Until recently prostate cancer has been something of a "Cinderella" condition.  GPs have been discouraged from using the PSA blood test, even in men specifically requesting them to do so.  But now there appears to be a significant change of attitude in the Department of Health.  It is preparing to inform GPs that all men should have the right to undergo a prostate specific antigen (PSA) blood test, but only after they have been provided with an information leaflet and they have given written informed consent.  How sensible is this approach?

Currently no data exist to confirm that prostate cancer screening results in either benefit or harm.  Although randomised screening studies are under way both in the USA and Europe, the results are not expected in under three years.  Evidence as to which treatment strategy is most effective is also lacking.  Randomised trials examining these questions are under way, including a new £13 million study in the UK but again no results are expected for some years.

Broadly sensible

The approach of the 'prostate cancer risk management programme' seems, therefore broadly sensible.  Men should be informed that PSA testing is capable of detecting prostate cancer at an early, potentially curable stage.  A discussion about the potential harms and benefits should then occur so that they can make an informed choice about screening for themselves.  This discussion should include the following points: the likelihood that cancer will be diagnosed, the possibility of false positives and negatives, the anxiety associated with a positive test, the diagnostic tests and treatment options available.  Studies have indicated that routinely providing such information reduces the number of men who decide to be tested, although a substantial number still elect to do so.  GPs and urologists need to be prepared to provide this information and should be broadly supportive of whichever choice their patients make.