Street drugs

August 2010

Professional

Prostate specific antigen

Useful screening tool or potential liability?

Volume 39, No.8, August 2010 Pages 598-600

Patrick Mahar

Shomik Sengupta

Karinne Ludlow

Niall Corcorane

Background

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.

Objective/s

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.

Discussion

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.

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.

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Correspondence afp@racgp.org.au

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