Diagnosis and management of early prostate cancer. Report of a British Association of Urological Surgeons Working Party

There is some evidence to support the proposition that early diagnosis and treatment of prostate cancer may be beneficial and could reduce the mortali ty from the disease. Despite this, the introduction of a screening programm e similar to those in place for breast and cervical cancer cannot be justif ied on current evidence, In the absence of alternative strategies to reduce mortality from prostate cancer, early diagnosis in appropriate circumstanc es should be encouraged. The establishment and Funding of adequate programm es to test the validity of population screening should be sought by BAUS an d such programmes should he supported by all urologists, Opportunist screen ing, without prior consent of the patient, by general practitioners (GPs), as part of health-check protocols, hospital admission investigations, etc. should be discouraged. Patients requesting PSA testing should be considered sympathetically, but PSA testing should only be performed after full couns elling. It is reasonable to comply with a patient's request if based on suc h information. Similar counselling should be given to patients with a famil y history or other risk factors if they seer; diagnostic testing. There is no evidence to support opportunist screening of such men, but men with a fa mily history will seek advice and this should be available. It is recommend ed that all prostate assessment clinic protocols are reviewed and as a mini mum, patients given written information that a PSA test is included in the protocol and an opportunity to opt out of the test if ther wish. Patients o ver 75 years old (or of an age to be agreed in local protocols) and those w ith conditions severely affecting life expectation, should only hare their PSA measured if there is clear clinical evidence that they may hare prostat e cancer for which treatment will be needed. Urologists must agree with the ir referring GPs and with their hospital colleagues on protocols of PSA use . Transrectal ultrasonography and prostatic biopsy must be carried out in u nits with adequate equipment and expertise. Clear criteria for biopsy must be agreed between those referring patients and those performing biopsies, b e they radiologist or urologist. ii protocol for further follow-up of men w ith raised PSA levels after a negative biopsy must be agreed, to minimize a nxiety and allow early discharge. The BAUS Section of Oncology must establi sh criteria for designating prostate cancer clinics where patients being co nsidered for radical prostatectomy or other active treatment can be counsel led. Urologists performing radical prostatectomy ideally should be attached to such centres, and should participate in audit as laid down by the Oncol ogy Section, and contribute to appropriate national trials.