Should GPs raise the topic of PSA testing with men?

This series showcases the contributions of Sax Institute researchers to papers published in peer-reviewed literature.

What was studied?

Researchers brought together 40 men and women in Sydney to form three “citizens’ juries”, which were briefed extensively on the evidence and dilemmas associated with Prostate Specific Antigen (PSA) testing as way of screening asymptomatic men for prostate cancer. The juries were convened amid ongoing debate about whether the benefits of PSA screening outweigh potential harms, which include the overdiagnosis of latent cancers that may never progress, resulting in those men having unnecessary repeated investigations and adverse effects of treatment.

The juries (two of mixed gender, one male-only) were informed about the issues surrounding PSA testing in men who do not have any symptoms of disease. Researchers then assessed whether the juries believed GPs should initiate the subject of PSA screening with male patients, and what information they thought GPs should provide to patients about the test.

The study aimed to ascertain what well-informed community members would accept as legitimate PSA testing policy and practice.

What are the key findings?

All three juries concluded that GPs should initiate discussions about PSA testing with asymptomatic men aged over 50 years. This approach differs to the Royal Australian College of General Practitioners’ (RACGP) advice to GPs not to broach the subject of PSA testing with patients unless asked, but to provide full information about testing to those who ask about it.

The two juries of mixed gender believed GPs should offer patients detailed information about all potential benefits and harms of PSA testing prior to the patient having the test. They also supported a “cooling-off’ period for patients to consider the pros and cons before testing.

The all-male jury – many of whom were already having routine annual PSA tests ‒ favoured a staggered approach to providing information. They believed written material about PSA testing should be available to those patients who wanted it, but two-thirds of jurors believed doctors should only discuss the benefits and harms of biopsy and treatment with patients who had received an elevated PSA result.

What was the conclusion?

Despite RACGP advice to the contrary, informed members of the public said GPs should raise the topic of PSA testing with men aged over 50, and explain the potential benefits and harms of the test, but they should tailor their information to individual patients.

What are the implications?

In light of the finding that well-informed community members want GPs to proactively raise the topic of screening with male patients, professional medical bodies should look at how GPs support patients in making decisions about whether to undergo PSA testing.

The paper

Degeling C, Rychetnik L, Pickles K, Thomas R, Doust MA, Gardiner RA, Glasziou P, Newson AJ, Carter SM. “What should happen before asymptomatic men decide whether or not to have a PSA test?” A report on three community juries. Med J Aust 2015;203(8):335