RecommendationAt initial assessment, offer men with LUTS information, advice and time to decide if they wish to have prostate specific antigen (PSA testing if:
RecommendationManage suspected prostate cancer in men with LUTS in line with ‘Prostate cancer: diagnosis and management’ (NICE clinical guideline 58) and ‘Referral guidelines for suspected cancer’ (NICE clinical guideline 27).
RecommendationAt specialist assessment, offer men with LUTS information, advice and time to decide if they wish to have prostate specific antigen (PSA testing if:
Relative values of different outcomesSymptom progression was considered the most important outcome.
Trade off between clinical benefits and harmsThe GDG felt that although it was important not to miss a case of prostate cancer it was essential to acknowledge that this test lacks accuracy and may cause more harm than benefit in terms of unnecessary worry for the patient. Therefore, the GDG decided that these men should be given information about the test so that they could make an informed decision whether to go ahead with it.
Economic considerationsThere is a trade-off between the cost of performing PSA and the useful information that this test could provide.
Quality of evidenceThere was no evidence comparing LUTS outcomes for men that had a PSA test compared to those that had not.

The ideal analysis for the prognostic question would be regression analysis identifying the link of baseline PSA levels with progression while controlling for other variables. This was performed in only some of the studies reviewed 46,229,255. Data suggesting that PSA has prognostic value in predicting symptom progression were inconsistent.
Other considerationsBecause PSA levels tend to increase with age, the use of age-specific PSA reference ranges has been suggested as a way of increasing the accuracy of PSA tests. However, age-specific reference ranges have not been generally favoured because their use may lead to missing or delaying the detection of prostate cancer in as many as 20 percent of men in their 60s and 60 percent of men in their 70s. Another complicating factor is that studies to establish the normal range of PSA values have been conducted primarily in white men.

From: 4, Diagnosis

Cover of The Management of Lower Urinary Tract Symptoms in Men
The Management of Lower Urinary Tract Symptoms in Men [Internet].
NICE Clinical Guidelines, No. 97.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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