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Published on: November 2, 2013
Unravelling the prostate-specific antigen controversy: a West of Scotland perspective
Nauman Zafar1, Steve Miller, Vicki Leburn
1Speciality Registrar in Urology, East Midlands Deanery, NHS England, UK.
Background:
The use of serum prostate-specific antigen (PSA) as a screening tool for prostate cancer in asymptomatic men is hugely controversial in the light of randomised controlled trials failing to demonstrate a benefit without risk of significant overtreatment. However, PSA can be used as a tool to risk assess disease progression in men with lower urinary tract symptoms suggestive of benign prostatic enlargement (LUTS/BPE). The aim of this study was to canvas the opinions of West of Scotland Urologists regarding the use of PSA in both symptomatic and asymptomatic patients.
Methods:
A questionnaire-based survey was sent to all the Consultants and Trainees in the West of Scotland.
Results:
Survey response rate was 45% (47/105). In patients <70 years, 93% would perform a PSA testing in patients symptomatic of LUTS/BPE, but only 17% would offer PSA screening to asymptomatic patients. In patients >70 years, only 48% of urologists would perform a PSA if patients were symptomatic and none would offer PSA screening. In terms of self-testing, 59% of urologists would have a PSA test if symptomatic and 31% of urologists would have PSA screening.
Conclusions:
This study highlights significant variability in the use of PSA for both asymptomatic and symptomatic men. Despite a lack of evidence, PSA screening is still offered to asymptomatic men. Further randomised studies are required to determine the utility of PSA-based screening algorithms for prostate cancer detection.
