Abstract
A 62-year-old man, whose friend has just been diagnosed with prostate cancer, consults with you. He is asymptomatic and requests to have a prostate specific antigen (PSA) test. He is surprised that there is no screening programme in the UK for prostate cancer and asks you why this is.
What are the criteria for an effective cancer screening programme?
Why is there no prostate cancer screening programme in the UK?
If you agree to conduct a PSA test, how would you counsel this man, particularly in view of the fact that he is asymptomatic?
You agree to request a PSA and the result comes back as 5.2 ng/ml (just above the age-specific limit). Rectal examination reveals a benign feeling, moderately enlarged prostate gland.
Which conditions or drugs can affect the PSA level?
How would you manage this patient and how would you explain the result to him?
Links
National Institute for Health and Clinical Excellence (NICE). Prostate cancer: diagnosis and treatment (2008). Accessed via www.guidance.nice.org.uk/CG58
NICE. Referral guideline for suspected cancer (2005; updated 2011). Accessed via www.guidance.nice.org.uk/CG27
NHS. Prostate cancer risk management programme. Accessed via www.cancerscreening.nhs.uk/prostate/index.html
UK National screening committee. Accessed via www.screening.nhs.uk
Schroder, F. et al. Screening and prostate cancer mortality in a randomized European study. New England Journal of Medicine (2009) 360: p. 1320–8
Andriole, G. et al. Mortality results from a randomized prostate cancer screening trial. New England Journal of Medicine (2009) 360: p. 1310–9