Difficult to make a well-informed decision about using the PSA test to screen for prostate cancer

Well-informed patients should not be denied a PSA test to screen for prostate cancer. In practice, however, most patients do not seem to be properly informed. Only half of the men given a PSA test undergo a rectal examination before the test is carried out. A physician who does not perform a rectal examination cannot be aware of the condition of the prostate and the patient will not be in a position to make a well-informed decision about whether or not he wants to be screened. GPs and non-urological medical specialists must provide men with more information and be more selective when ordering PSA tests to screen for prostate cancer. These are the findings of research carried out by urologist Saskia van der Meer of the UMCG. She will be awarded a PhD for her thesis by the University of Groningen on 21 October.

The use of the PSA test is controversial. The value of the test is unclear and the medical guidelines vary in terms of advice, recommendations and follow-up procedures. As a result, the PSA test is not the ideal method for screening for prostate cancer and many GPs are reluctant to use it.

No uniform way of providing information

In her research, Saskia van der Meer shows that the initiative for a PSA test can lie with the patient, the specialist or the GP. Patients may ask for a test because they are having lower urinary tract symptoms and are worried about prostate cancer. Informing patients about the pros and cons of the PSA test seems not to be adequate and so patients are not in a position to make a properly informed decision about whether or not to be screened. Van der Meer would like to see more research into an impartial, uniform way of providing information and the effect this would have on patient satisfaction regarding their choice.

PSA testing policies vary

Van der Meer’s research also showed that the PSA testing policies by GPs and non-urological medical specialists varied enormously and did not comply with the guidelines. Instead of arranging follow-up for patients with a moderately elevated PSA level, older patients and patients with comorbidities tended to be reassured or sometimes not even informed about the test results, because this group is thought to have a low risk of developing a clinically relevant prostate carcinoma. This policy is implemented to avoid the damage that further testing may cause. However, it raises the question of whether some of these patients should be screened in the first place.

The Prostaatwijzer

The Prostaatwijzer is a risk calculator devised by the Prostate Cancer Research Foundation (SWOP). The calculator estimates patients’ individual risk of developing prostate cancer. Van der Meer recommends validating this risk calculator for use in primary healthcare. It could reassure patients at an earlier stage and prevent unnecessary distress if their PSA level is elevated. GPs would also be in a better position to offer advice about possible follow-up tests, and it could lead to fewer referrals and ensuing treatment.

Curriculum vitae

S. van der Meer (Leeuwarden, 1978) studied Medicine at the University of Groningen. She carried out her PhD research in the Urology Department of the Isala hospital in Zwolle and the University Medical Center Groningen. The title of her thesis is Prostate-Specific Antigen Testing Policy; Non-Urologists and Guideline Adherence. She works as a urologist in the UMCG and is currently a fellow in endo-urology and urological oncology.