[Changes to Dutch College of General Practitioners guideline 'Micturition problems in men']

Major disadvantages are associated with the early diagnostics of prostate cancer; for this reason routine determination of PSA level is not recommended in the Netherlands. If, after guidance, the patient still wants further investigations and rectal examination is not abnormal, the Dutch College of General Practitioners guideline 'Micturition problems in men' recommends that a PSA test should be done. The cut-off PSA level for referring patients for secondary care has been lowered from 4 ng/ml to 3 ng/ml, meaning that this guideline is now in accordance with the Dutch Society for Urology's multidisciplinary guideline "Prostate Carcinoma". Using the Prostate Cancer Risk Calculator (Prostaatwijzer-3), the PSA level and ultrasound-guided measurement of prostate volume can be used to calculate the risk of prostate cancer. The risk calculated is then used a starting point in determining if invasive follow-up diagnostic tests should be implemented.