RCPA recommendations for PSA testing

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The Royal College of Pathologists of Australasia have released a position statement statement on PSA testing for the diagnosis of prostate cancer in the latest edition of the journal ‘Pathology’ (McKenzie P, Delahunt B et al. Prostate specific antigen testing for the diagnosis of prostate cancer. Pathology (Aug 2011); 43 (5): p403) .

Important excerpts from the editorial include;

  • “Men seeking to assess their risk of prostate cancer should be offered PSA testing and a DRE (digital rectal examination) from the age of 40 years as a baseline measure. PSA measurements performed in men under the age of 50 years are predictive of future risk, rather than being a measure to detect the very small number of incident cases within this age group”
  • The ability of PSA to predict risk of prostate cancer is enhanced by the use of
    • (i) age-related PSA reference limits – “PSA levels above the age-related upper reference limit carry an increased risk of prostate cancer and should be followed up immediately”.
    • (ii) age-related PSA medians – “men with PSA levels above the median have above average risk and should be tested annually”.
    • (iii) free to total PSA ratio – “In patients with a result above the age-related reference interval a low free to total PSA ration (below 10%) represents a high risk of prostate cancer and should be followed up immediately”.
    • (iv) estimation of the rate of PSA rise – “A PSA rise that equates to a doubling time taht is faster than three years or a rise of more than 0.75μg/L per year represents a high risk that should be followed up immediately”.

The full editorial can be viewed on-line here.

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