The use of prostate specific antigen testing in the detection of localizedprostate cancer - Current opinion and urological practice in the United Kingdom

Background: The prostate-specific antigen (PSA) test and its interpretation plays a crucial role in the detection of early localized prostate cancer. However, inaccuracy of the test, inability to predict the aggressiveness of the disease a nd the lack of evidence about the comparative effectiveness of treatments have led to major dilemmas in considering whether to employ t he PSA test and which cut off points to use in interpreting its results. Th e aim of this study was to evaluate current urological practice in the UK r egarding the use of PSA testing. Methods: A postal questionnaire survey of ail consultant urologist members of the British Association of Urological S urgeons was conducted. Statistical analysis included proportional odds regr ession models to examine factors associated with urologists' preferences fo r different definitions of 'normal' PSA cut-off levels, Results: The survey response rate was 60%, The majority of consultant urologists applied the P SA test routinely, There was a high level of agreement amongst UK urologist s on normal PSA cut-off points (<4.0 ng/ml) for asymptomatic men under 60 y ears of age, There was very wide variation in the definition of normal PSA cut-offs for older (<greater than or equal to>60 years) asymptomatic men. A preference for lower cut off points, leading to investigation with ultraso und and biopsy, was significantly associated with larger urology department size, the presence of a prostate cancer subspecialist in the department an d relatively short length of specialization in urology. Conclusions: Prosta te cancer screening and early detection practices and reported incidence ra tes of the disease are likely to be influenced by variation in urologists' interpretations of PSA. Despite increasing evidence in favour of lower PSA cut-off levels, particularly for younger men (<60 years), urologists in the UK are divided over their interpretation. Men, particularly over age 60 ye ars, have varying chances of further investigation following PSA testing. A ny trial of prostate cancer screening or treatment should take this potenti al variation into account, Standard protocols for PSA interpretation should be implemented.