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[PSA: the difficult position of general practitioners between patients and urologists]
Sébastien Vincendeau1, Maroun Abi Moussa, Andréa Manunta
1Service d'Urologie, CHU Pontchaillou, rue Henri Le Guilloux, 35033 Rennes, France. vindendeausebas@yahoo.fr
Objective:
To determine the reasons for ordering PSA assay and delayed referral to an urologist following detection of elevated PSA in general practice.
Material And Method:
Retrospective study of 200 patients referred to the department by general practitioners for elevated PSA from September 2000 to April 2001.
Results:
The median age was 67 years (range: 52 to 87). The median PSA was 7.9 ng/ml (range: 4.1 to 897). Patients were referred after 1 to 5 PSA assays (mean: 1.6) with a median interval after discovery of elevated PSA of 1.7 months. The referral time was greater than 6 months for 52 patients (26%) and 31 patients (15.6%) were referred after more than two PSA assays were found to be elevated. PSA assay was ordered in the absence of symptoms or abnormal digital rectal examination in 43% of patients over the age of 70 years.
Conclusion:
Prostate cancer screening is regularly performed in general practice. The information given to general practitioners, faced with a well informed population, appears to be insufficiently clear, as PSA assay is sometimes incorrectly ordered or interpreted.