PSA Consensus

In 2015, Prostate Cancer UK led a project whose aim was to achieve a clinical consensus on PSA testing for men without symptoms. Working with key parties from across the UK including Tackle, a set of 13 consensus statements was published in March 2016. You can read the statements below.

Commenting on the statements, Dr Jon Rees - a GP and member of our Clinical Advisory Board - said "The controversy that surrounds PSA testing for asymptomatic men means that most GPs face constant uncertainty in how to offer a sensible, evidence-based approach to this problem. This approach, however, also needs to be based on pragmatism – men are understandably concerned about prostate cancer, and a ‘no-testing’ policy is utterly unrealistic in real life primary care".

Tackle have also issued their response to the statements which you can read here.

Statement 1

In the future, health professionals should look at a man’s PSA level alongside other known risk factors as part of a risk assessment tool, when one becomes available.

Statement 2

GPs and practice nurses should know what may increase a man’s risk of getting prostate cancer.

Statement 3

GPs and practice nurses should be prepared to start conversations about the pros and cons of the PSA test with men who have a higher risk of getting prostate cancer.

Statement 4

The government and health organisations, with help from health professionals and charities, should make sure men know about their risk of prostate cancer, and about general prostate health.

Statement 5

All men should be able to have a PSA test if they’re over 50. Men who have a higher risk of prostate cancer should be able to have a PSA test if they’re over 45.

Please note that the NHS Prostate Cancer Risk Management Programme guidance states that "the PSA test is available free to any man aged 50 or over who requests it, after careful consideration of the implications".

Statement 6

If a man is thinking about having a PSA test, his GP or practice nurse should talk to him about the pros and cons. This should help the man decide whether or not to have a PSA test.

Statement 7

If a man has no symptoms of a prostate problem and is clearly likely to live for less than 10 more years, his GP or practice nurse should advise him not to have a PSA test.

This is because a man in this situation is unlikely to benefit from having the test. Early prostate cancer doesn’t usually cause any symptoms. It often grows slowly and has a low risk of spreading. So it may never cause any problems in a man’s lifetime or affect how long they live.

Statement 8

If a man decides to have a PSA test, his GP should offer him a digital rectal examination (DRE) as well, even if he has no symptoms of a prostate problem.

Statement 9

Even if a man has no symptoms of a prostate problem, he should be referred to a specialist at the hospital for more tests if:
 
  • he has a higher risk of prostate cancer, and
  • he is aged between 45 and 49 years, and
  • his PSA level is higher than 2.5 ng/ml.

Statement 10

When deciding whether to refer a man to a specialist at the hospital, GPs and practice nurses should look at the man’s previous PSA test results. They should look at any rise in the man’s PSA level, even if their PSA level is still ‘normal’ for their age.

A ‘normal’ PSA level is less than 3ng/ml for men aged 50-69.

Statement 11

Men with a ‘normal’ PSA level should be able to have another PSA test in the future, even if they still have no symptoms of a prostate problem.

This is known as repeat testing. Men should discuss how often to have a PSA test with their GP or practice nurse. This will depend on that man’s risk of getting prostate cancer.

Statement 12

Men over the age of 40 who have no symptoms of a prostate problem should think about having a PSA test to help work out their risk of getting prostate cancer later in life.

This is known as a ‘baseline’ PSA test. If a man aged between 40 and 49 years has a PSA level higher than 0.7ng/ml, this may mean he has a higher risk of getting prostate cancer. He and his GP or practice nurse should talk about having regular PSA tests in the future. This might be a good way to spot any changes in the man’s PSA level that might suggest prostate cancer.

Statement 13

The PSA test (with or without a digital rectal examination) should not be used in a national screening programme for men in the UK.

Source: Prostate Cancer UK. Consensus statements on PSA testing in asymptomatic men in the UK - Information for patients and the public. 2016. Available from: www.prostatecanceruk.org/PSAconsensus