------- Forwarded message follows -------
From: "Mike France" <[log in to unmask]>
To: [log in to unmask],
"C J Seneviratne" <[log in to unmask]>
Date sent: Tue, 4 Jul 2000 14:43:05 BST
Subject: Re: PSA Measurements
Copies to: [log in to unmask]
Priority: normal
> The "Guidelines for Urgent Referral of Patients with Suspected
> Cancer" provides indications for Urgent 2 week referrals for certain
This is a lack of communication between the right and left
hands or possibly of the brain between them.
Prostatic cancer suspected on what grounds? If the sole
reason is a PSA level then screening has taken place. If
testing is restricted to symptomatic men then the number
of younger men will be small.
EL(97)12 June 1997, and still current, from our employer
the NHS Executive specifically asks Health Authorities
( and GP fundholders ) not to plan the purchase of
screening. Therefore from the laboratory point of view-no
money-and a formal ban on the indication, which will
block any attempt to bid for funds.
Outwith a formal screening programme testing for PSA
fails on each of the four conditions for effecive screening
laid down by the UK National screening committee
including the ability of a 50 year old man with a PSA
above his age adjusted reference range to assess what
he is in for.
Chris Price ( for the ACB ) is in the final stages of
producing a report commissioned by the Health
Technology Assessment Group ( NHS - I believe ) on the
issues related to PSA testing and the statistical problems
in relation to cut-offs have been addressed at length for
both symptomatic and asymptomatic individuals. This is
preliminary to considering the merits of a pilot screening
programme. Methodological differences are clearly very
important. It is difficult for individual laboratories to
produce appropriate reference range data
The criteria for referral to a urologist need to be clarified
in terms of the context. There is no place for ad hoc
testing. One fact that I have gleaned from working closely
with urologists is that prostatic biopsy is rather painful and
no fun at all. Therefore the pros and cons need to be
worked out with the individual very carefully.
Mike France
>
Dr MW France
------- End of forwarded message -------
Dr Rick Jones
Director of Chemical Pathology and Immunology
Institute of Pathology
Tel:(44)-113-233-5677
Fax:(44)-113-233-5672
http://www.acb.org.uk
http://www.yichi.org.uk
http://www.leeds.ac.uk/rdinfo //Winner - Best Health Database HC99
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