• Br J Gen Pract · Aug 2024

    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.

    • Thomas A Harding, Richard M Martin, Samuel Wd Merriel, Robert Jones, Joe M O'Sullivan, Mike Kirby, Oluwabunmi Olajide, Alexander Norman, Jaimin Bhatt, Oliver Hulson, Tanimola Martins, Vincent J Gnanapragasam, Jonathan Aning, Meg Burgess, Derek J Rosario, Nora Pashayan, Abel Tesfai, Natalia Norori, Amy Rylance, and Andrew Seggie.
    • Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
    • Br J Gen Pract. 2024 Aug 1; 74 (745): e534e543e534-e543.

    BackgroundScreening 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.AimTo 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 SettingProstate Cancer UK facilitated a RAND/UCLA consensus.MethodStatements 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.ResultsOf 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.ConclusionImprovements 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.© The Authors.

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