PSA testing in men without symptoms

New study shows level of testing exceeding guideline recommendations

Measurement of Prostate Specific Antigen or PSA is an important test in the detection of prostate cancer but there is an ongoing debate about how it should be used particularly in men who have no symptoms of cancer. Accordingly, the National Health and Medical Research Council and the Royal College of General Practitioners of Australia do not recommend PSA as a screening test in men who have no symptoms and no family history of prostate cancer.

The Prostate Cancer Foundation recommend that men aged 50 to 69 who have no symptoms consider checking their PSA level every two years after they have discussed the pros and cons of testing with their doctor. However, a recent study shows that this guideline is not being followed and many men are having their PSA measured more often.

The study published in the Medical Journal of Australia investigated PSA levels in 142,016 asymptomatic patients from 180 general practices in Victoria. The results of the analysis showed that PSA increases with age by about three per cent each year and, given the large number of men tested, this confirms that age-specific ranges for PSA data should be used when interpreting PSA levels in an individual patient.

The second important finding was that testing more than once in the two-year period was highest in the 70 to 74 age group whereas the Prostate Cancer Foundation guidelines recommended testing only up to the age of 69. The data confirms findings from earlier studies but the reasons for such increased testing rates remain unclear.

In an accompanying podcast, two of the investigators speculate why older men are continuing to get tested and more frequently. Reasons include possible heightened awareness of prostate cancer in the general population, in which case it emphasises the importance of patients discussing with their doctor the benefits and harms of investigations that can take place as a follow up to a raised PSA level such as prostate biopsy.  More about this and other aspects of PSA testing can be found on this website.

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