Open Access Highly Accessed Research article

Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review

Saskia Van der Meer1, Sabine AM Löwik2, Willem H Hirdes1, Rien M Nijman3, Klaas Van der Meer2, Josette EHM Hoekstra-Weebers4 and Marco H Blanker2*

Author Affiliations

1 Isala clinics, Department of Urology, Groot Wezenland 20, 8011, JW, Zwolle, The Netherlands

2 Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700, RB, Groningen, The Netherlands

3 Department of Urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700, RB, Groningen, The Netherlands

4 University of Groningen, University Medical Center Groningen, Psychosocial services Hanzeplein 1, P.O.Box 30.001, 9700, RB, Groningen, The Netherlands

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BMC Family Practice 2012, 13:100  doi:10.1186/1471-2296-13-100

Published: 11 October 2012

Abstract

Background

Prostate specific antigen (PSA) testing is widely used, but guidelines on follow-up are unclear.

Methods

We performed a systematic review of the literature to determine follow-up policy after PSA testing by general practitioners (GPs) and non-urologic hospitalists, the use of a cut-off value for this policy, the reasons for repeating a PSA test after an initial normal result, the existence of a general cut-off value below which a PSA result is considered normal, and the time frame for repeating a test.

Data sources. MEDLINE, Embase, PsychInfo and the Cochrane library from January 1950 until May 2011.

Study eligibility criteria. Studies describing follow-up policy by GPs or non-urologic hospitalists after a primary PSA test, excluding urologists and patients with prostate cancer. Studies written in Dutch, English, French, German, Italian or Spanish were included. Excluded were studies describing follow-up policy by urologists and follow-up of patients with prostate cancer. The quality of each study was structurally assessed.

Results

Fifteen articles met the inclusion criteria. Three studies were of high quality. Follow-up differed greatly both after a normal and an abnormal PSA test result. Only one study described the reasons for not performing follow-up after an abnormal PSA result.

Conclusions

Based on the available literature, we cannot adequately assess physicians’ follow-up policy after a primary PSA test. Follow-up after a normal or raised PSA test by GPs and non-urologic hospitalists seems to a large extent not in accordance with the guidelines.

Keywords:
Prostate specific antigen; PSA; Follow-up; General practitioners; Non-urologic hospitalists; Guidelines; Systematic review