Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus.

Harding, TA.; Martin, RM.; Merriel, SW.; Jones, R.; O'Sullivan, JM.; Kirby, M.; Olajide, O.; Norman, A.; Bhatt, J.; Hulson, O.; Martins, T.; Gnanapragasam, VJ.; Aning, J.; Burgess, M.; Rosario, DJ.; Pashayan, N.; Tesfai, A.; Norori, N.; Rylance, A.; Seggie, A.

Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus.

All Authors

Harding, TA.

Martin, RM.

Merriel, SW.

Jones, R.

O'Sullivan, JM.

Kirby, M.

Olajide, O.

Norman, A.

Bhatt, J.

Hulson, O.

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LTHT Author

Hulson, Oliver

LTHT Department

Radiology

Publication Date

2024

Item Type

Journal Article

Abstract

BACKGROUND: Screening is not recommended for prostate cancer in the UK. Asymptomatic men aged >=50 years can request a prostate-specific antigen (PSA) test following counselling on potential harms and benefits. There are areas of clinical uncertainty among GPs, resulting in the content and quality of counselling varying. AIM: To produce a consensus that can influence guidelines for UK primary care on the optimal use of the PSA test in asymptomatic men for early prostate cancer detection. DESIGN AND SETTING: Prostate Cancer UK facilitated a RAND/UCLA consensus. METHOD: Statements covering five topics were developed with a subgroup of experts. A panel of 15 experts in prostate cancer scored (round one) statements on a scale of one (strongly disagree) to nine (strongly agree). Panellists met to discuss statements before rescoring (round two). A lived experience panel of seven men scored a subset of statements with outcomes fed into the main panel. RESULTS: Of the initial 94 statements reviewed by the expert panel, a final 48/85 (56%) achieved consensus. In the absence of screening, there was consensus on proactive approaches to initiate discussions about the PSA test with men who were at higher-than-average risk. CONCLUSION: Improvements in the prostate cancer diagnostic pathway may have reduced some of the harms associated with PSA testing; however, several areas of uncertainty remain in relation to screening, including optimal PSA thresholds for referral and intervals for retesting. There is consensus on proactive approaches to testing in higher-than-average risk groups. This should prompt a review of current guidelines.