The use of prostate specific antigen (PSA) as a screening tool for prostate cancer has long been a subject of investigation and debate. Until recently, very little evidence in the form of randomised trials existed advocating for or against the use of the test. This, coupled with the well documented risks that may result from overdiagnosis and overtreatment following false positive PSA,1,2 may cause apprehension among primary care physicians concerned about potential legal ramifications of adverse outcomes following unnecessary screening.
The uncertainty regarding prostate specific antigen (PSA) screening
for prostate cancer has not been alleviated, despite recent randomised
controlled trials and position statements released by authoritative bodies.
This article summarises authoritative position statements by
representative bodies in Australia and describes legal considerations for
a general practitioner when deciding whether to order PSA tests as a
screening tool for prostate cancer.
Prostate specific antigen as a primary screening tool is generally not
endorsed by most authoritative bodies in Australia, with the exception in
some circumstances for men 55–69 years of age. Where asymptomatic
patients request a PSA be undertaken, a GP can be justified both to
order a PSA test or not to, such is the context of peer professional opinion
provisions in Australian legislation and conflicting authoritative position
statements regarding PSA.Where there is still ongoing uncertainty, the
matter may be appropriately referred for specialist consideration.
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