Consensus statements on PSA testing in asymptomatic men in the UK - information for health professionals
The consensus statements
We've produced a set of statements, representing the consensus view of hundreds of health professionals, to support primary health care professionals to use the PSA test more effectively for men without symptoms of prostate cancer. The set of thirteen consensus statements, providing additional guidance to Public Health England's Prostate Cancer Risk Management Programme (PCRMP), will drive improvements in the early detection of prostate cancer in men without symptoms whilst aiming to avoid over treatment and reduce variation in practice.
A man’s PSA level should be built into a validated risk assessment tool, when available, alongside other known risk factors to better assess a man’s risk of prostate cancer and aid in the decision-making process.
We're working with international experts to change the way prostate cancer is diagnosed across the UK by developing a risk prediction tool for primary care practice.
Primary healthcare professionals need to be aware of the factors that put men at higher than average risk of prostate cancer.
Increasing age, Black ethnicity and a family history of prostate cancer put men at higher than average risk of prostate cancer. Find out more information on prostate cancer risk factors.
Primary healthcare professionals need to be prepared to have proactive conversations with men at higher than average risk of prostate cancer about prostate cancer risk and the PSA test.
Governments and public health agencies have primary responsibility for raising awareness of prostate health and prostate cancer risk factors amongst men in the UK, with relevant contribution from healthcare professionals and charities.
The use of targeted messaging should be considered.
All men should be able to access PSA testing from the age of 50, but men at higher than average risk of prostate cancer should be able to access the PSA test from the age of 45.
The PCRMP guidance states that "The PSA test is available free to any man aged 50 or over who requests it, after careful consideration of the implications".
When a PSA test is being considered, primary healthcare professionals should provide balanced information on the pros and cons of the PSA test in order to allow the man to make up his own mind on whether to have the test.
Asymptomatic men with a life expectancy clearly less than 10 years should be recommended against an initial or repeat PSA test as they are unlikely to benefit.
We acknowledge that further work is required to better estimate an individual’s life expectancy.
GPs should offer a digital rectal examination (DRE) to all asymptomatic men who have decided to have a PSA test.
Asymptomatic men at higher than average risk of prostate cancer who have a PSA test between the ages of 45 and 49 should be referred for further investigations if their PSA level is higher than 2.5ng/ml.
This recommendation is based on the limited evidence currently available, and may need to be reviewed if further information becomes available.
PSA history and a rising PSA (whilst still under the referral threshold) should be taken into consideration when deciding whether to refer to secondary care.
The PCRMP states the new recommended prostate biopsy referral value for men aged 50-69 years is ≥3ng/ml.
Asymptomatic men who have a PSA level below the threshold referral value for their age should not be denied a repeat PSA test. Re-testing intervals should be individualized following a discussion incorporating prostate cancer risk factors.
Asymptomatic men over 40 should consider a single “baseline” PSA test to help predict their future prostate cancer risk.
If the PSA level is above the age-specific median value, they should be considered at higher than average risk of prostate cancer and should be encouraged to be re-tested in the future.
The age-specific median value for men aged 40-49 years is 0.7ng/ml.
The PSA test, even when combined with the DRE, should not be used in a UK population-wide screening programme for asymptomatic men.
Read our policy position on the PSA test, which includes more information on why there is no national screening programme using the PSA test in the UK.
How the consensus was developed
This project was funded through charitable funds which were not provided by the pharmaceutical industry or any medical device or treatment company.
The consensus statements have been endorsed by the British Association of Urological Nurses (BAUN), the British Association of Urological Surgeons (BAUS) and the Primary Care Urology Society (PCUS):
Fiona Sexton, BAUN President:
"The British Association of Urological Nurses (BAUN) have been delighted to support the development of these consensus statements on PSA testing in asymptomatic men in the UK.
It is extremely important that all men can easily access accurate and balanced information regarding the risks and benefits of PSA testing for their own individual circumstances, to understand their individual risk and be guided through the process of deciding whether PSA testing is right for them. The consensus statements set this out clearly and will be a valuable aid to all those involved in the decision making process".
Mr Simon Brewster, Consultant Urological Surgeon and BAUS Oncology Executive Committee member:
"While the British Association of Urological Surgeons (BAUS) recognises that the evidence for population serum PSA screening to save prostate cancer deaths is not currently strong enough to offset the risk of unnecessary treatment of too many men, the consensus statements made by Prostate Cancer UK are supported by BAUS.
The statements focus attention on risk (of developing prostate cancer) and draw on what is known about PSA levels in relatively young men in the years before the PSA may rise to exceed the age-specific normal ranges. These statements may help primary care practitioners to give sound advice to asymptomatic men under their care".
Dr Jon Rees, GP and Chair of the Primary Care Urology Society:
“The controversy that surrounds PSA testing for asymptomatic men means that most GP’s face constant uncertainty in how to offer a sensible, evidence based approach to this problem. This approach, however, also needs to be based on pragamatism – men are understandably concerned about prostate cancer, and a ‘no-testing’ policy is utterly unrealistic in real life primary care.
The consensus statements published by Prostate Cancer UK offer GP’s some key messages on PSA testing. The word ‘risk’ appears frequently through the statements – a PSA test is, for most men, highly unlikely to be a diagnostic test – it is only when the result is very high that a diagnosis of prostate cancer can be made confidently as a result of the PSA test. For the vast majority, therefore, a PSA test is a ‘risk assessment’ tool – however, we consistently fail to make decisions on whether to test, and on whether to refer for prostate biopsy, based on an individualised assessment of risk, relying instead on the PSA ‘normal range’ alone. These statements make a strong case for better risk assessment in primary care, and hopefully better targeting of high risk men, whilst at the same time reducing unnecessary interventions for those at low risk.
The Primary Care Urology Society welcomes this consensus statement, and looks forward to working with Prostate Cancer UK to ensure its dissemination to a primary care audience”.
Any questions? Contact us
Page last updated: March 2016