The role of PSA testing has to remain one of the biggest controversies facing us in primary care. Prostate cancer is most common cancer in men in the UK, making up just over a quarter of all male cancers, and the second biggest cause of male cancer death, with over 10,000 men dying from the disease every year in the UK alone.
Unlike many other cancers, we have a test, in the form of PSA, which can help us pick up prostate cancer before it has caused symptoms. However, as we all know, this does not mean that there is a simple argument to suggest that all men should have regular PSA testing. But, amidst this controversy, it is simply unacceptable, in my opinion, to take a nihilistic approach to the use of PSA in primary care – men are understandably not prepared to accept this, and it is up to us in primary care to come up with a sensible pragmatic approach, that maximises the pick up of clinically significant cancer, whilst minimising the harm from over-diagnosis and over-treatment of low grade, indolent tumours. As a recent editorial in a leading urological journal stated, it is not the time to stop the use of PSA testing, but to stop the misuse of the test.
As chair of the Primary Care Urology Society and of the education advisory group at Prostate Cancer UK, I have been involved in the formulation of the new consensus statements on PSA testing. Clearly, with a topic that creates so much strong feeling, it would be impossible to create a set of statements on this topic which will be universally agreed by all parties. However, the 13 statements produced by a diverse group of healthcare professionals and prostate cancer patients, give a really strong framework for primary care physicians to help guide their PSA decision making.
These statements will be used to help form the backbone of the PSA training that is delivered to practitioners via the Prostate Cancer UK Primary Care Masterclasses. The masterclasses have run for a number of years in venues all round the UK, covering all aspects of prostate disease, including benign prostatic enlargement and prostatitis, as well as PSA, prostate cancer (including a patient perspective) and sessions on side effects and sexual function. With changes to PSA guidance from NHS England in the form of the updated Prostate Cancer Risk Management Programme, and these consensus statements, I would strongly encourage my fellow GP’s to attend one of these free study days – the feedback from previous attendees has been fantastic, and we try hard to design the education around the needs of primary care – come along and see for yourself!