PSA testing in general practice: can we do more now?

Pinnock, Carole B

doi:10.5694/j.1326-5377.2004.tb05989.x

Topics

The debate over prostate-specific antigen (PSA) testing for prostate cancer has been prolonged, public, and sometimes acrimonious. Despite this, a common theme is present in most evidence-based guidelines produced to date: while population-based screening cannot be advocated currently, individuals considering a test should be fully informed about the pros and cons and make their own decisions. 1-3 The US Preventive Services Taskforce adds that individuals “be assisted in considering their personal preference and risk profile”.4 However, none of these guidelines address the issue of how to ensure such “informed choice”.

Urology Unit, Repatriation General Hospital, Daw Park, SA.

Correspondence:

1. Australian Health Technology Advisory Committee. Prostate cancer screening. Canberra: AGPS, 1996.
2. Screening for prostate cancer: the evidence. Information for men considering or asking for PSA tests. Centre for Reviews and Dissemination: University of York, York; 1997. Available at: www.urosoc.org.au/info/ainfo.html (accessed Feb 2004).
3. Smith R, von Eschenbach A, Wender R, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA Cancer J Clin 2001; 51: 38-75.
4. Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 137: 917-929.
5. Slevin T, Donnelly N, Clarkson J, et al. Prostate cancer testing: behaviour, motivation and attitudes among Western Australian men. Med J Aust 1999; 171: 185-188.
6. Weller D, Pinnock C, Silagy C, et al. Prostate cancer testing in South Australian men: influence of sociodemographic factors, health beliefs and lower urinary tract symptoms. Aust N Z J Public Health 1998; 22: 400-402.
7. Pinnock C, Weller D, Marshall V. Self-reported prevalence of prostate specific antigen (PSA) testing in South Australia: a community study. Med J Aust 1998; 169: 25-28. <MJA full text>
8. Towle A. Framework for teaching and learning informed shared decision-making. BMJ 1999; 319: 766-771.
9. Gattellari M, Ward J. Does evidence-based information about screening for prostate cancer enhance consumer decision-making? A randomised controlled trial. J Med Screen 2003; 10: 27-29.
10. O’Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions [update of Cochrane Database Syst Rev 2001; (3): CD001431]. Cochrane Database Syst Rev 2003; (2): CD001431.
11. “Is it my Prostate, Doc?” A guide for general practitioners. Canberra: National Health and Medical Research Council, 1997. Available at: www.health.gov.au/nhmrc/publications/pdf/cp43.pdf (accessed Mar 2004).
12. Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 2002; 347: 781-789.

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