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Updated prostate cancer test guidance for asymptomatic men

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The PSA test is the first line in cancer diagnosis The PSA test is the first line in cancer diagnosis

Public Health England has released an improved cancer pack containing information for GPs and practice nurses to use an initial prostate cancer test more effectively.

The prostate specific antigen test (PSA) can be done at a GP surgery to measure the level of PSA in the blood and is the most common initial test for men who are worried about prostate cancer. The test is applicable for otherwise healthy men who are concerned about the risks. It does not apply to men at high risk or with symptoms of any age.

The Prostate Cancer Risk Management Programme will guide men and primary care professionals when deciding whether to have a PSA test.

Dr Anne Mackie, Public Health England's director of screening, said: 'The decision about whether a man takes a PSA test is a complex one and has to be thought through carefully.

'There are potential harms as well as benefits in taking the test and we know that many men really appreciate the opportunity to discuss the test with their GP. Our new information pack will make it easier for GPs to have conversations with their patients, and assist men in making a decision that is right for them,' she said.

Current PHE guidance states that all men over 50 are entitled to a PSA test after a balanced conversation with a primary healthcare professional.

Prostate Cancer UK and a panel of independent experts have also released 13 consensus statements on aspects of PSA testing where evidence is lacking. These include looking at ethnicity and age in men who request tests.

Heather Blake, director of support and influencing at Prostate Cancer UK, said that the charity has set an ambition to reduce the number of deaths from prostate cancer by half over the next decade, which can oly be achieved if diagnosis is 'dramatically improved'. 'Until then [primary care professionals] must act to make sure that the PSA test becomes our best means of achieving early detection of prostate cancer in men without symptoms, especially those at higher than average risk. We are proud to have facilitated development of a consensus on PSA testing. Currently one man dies every hour from prostate cancer, we want to see this additional guidance used to support primary health care professionals to detect more cancers early, while continuing aiming to avoid over-treatment.'

The PSA test has been deemend not accurate enough to become part of a national screening programme. The UK National Screening Committee (UK NSC) has said that they will not recommend screening until there is clear evidence that it offers more benefit than harm to the population as a whole.

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The PSA, on its own, is not an accurate test. However, when you take into consideration the IPSS responses and DRE findings it is a useful aid. Also it is surely the percentage increase in the PSA that is more relevant than being within the normal range perhaps? My own PSA, although outside the normal range for my age, rose significantly in % over 18 months; my IPSS was moderate to severe and I have been diagnosed with prostate cancer following MRI and biopsies. The IPSS and DRE are necessary, and take only a few minutes to complete within a 15 minute appointment; PSA can be done if indicated by these simple preliminaries.
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