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Open Access Highly Accessed Research article

The trends in prostate specific antigen usage amongst United Kingdom urologists – a questionnaire based study

Helena P Burden1*, Chris R Davis2, Sophie Tate3, Raj Persad4, Chris H Holmes5 and Kate Whittington6

Author Affiliations

1 Urology Speciality Registrar, Derriford, Plymouth, UK

2 Foundation 1, Southmead Hospital, Westbury-upon-Trym, Bristol, BS10 5NB, UK

3 Faculty of Medical and Veterinary Sciences, University of Bristol, School of Medical Sciences, University Walk, Bristol, BS8 1TD, UK

4 Urology Department, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK

5 Clinical Sciences South Bristol, St. Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK

6 Clinical Sciences South Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK

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BMC Urology 2008, 8:17  doi:10.1186/1471-2490-8-17

Published: 20 November 2008

Abstract

Background

Worldwide, the use of prostate specific antigen (PSA) testing as a screen for prostate cancer is contentious. Whilst there is no National UK Screening programme, many men undergo opportunistic screening. This study investigates UK urologist's usage of PSA and the awareness surrounding the Department of Health (DoH) PSA guidelines.

Methods

Urologists were sent a questionnaire regarding PSA cut-off values.

Results

Of the 733 urologists eligible to participate in this study 346 returned completed questionnaires giving a response rate of 47%. The most commonly generally used age-related PSA cut-off values (36% of respondents) are – 3.5 ng/ml for 50 – 59 year olds, 4.5 ng/ml for 60 – 69 year olds and 6.5 ng/ml for over 70 year olds. Two-thirds (58%, 200/346) of respondents were aware of the DoH PSA guidelines but only 20% (n = 69/346) follow these guidelines. The majority of respondents (68%, n = 234/346) used higher PSA cut-offs than recommended by the DoH. The level of compliance showed marked regional variation with a range from 7% to 44% (median 19%). In addition, it was apparent that lower PSA cut-off values were used in private practice as opposed to the National Health Service.

Conclusion

A nationwide lack of agreement on PSA cut-off values may generate a variable standard of care both regionally and in NHS versus private practice. Generally, higher PSA cut-off values are being used than recommended by the DoH guidance.