Hi Dr. Walker,
Here is my "two cents" from over the POND! I recently reviewed global
jurisdiction practices wrt PSA testing in asymptomatic populations.
I share your (and those of others) concerns as we are facing similar issues
with PSA testing in Canada & USA. Some jurisdictions in Canada were more
proactive than us here in Winnipeg...namely public healthcare funds were
never used to pay (at least in theory) for PSA testing in asymptomnatic men.
The test was however available at a cost in the private lab system.
Unfortunately we have done all the PSA testing (by Bayer Immuno-1) in the
public system since a few years and this has grown to a cost of over 0.5
million dollars from our global budget (primarily due to screening
requests); certainly we are attempting a re-dress at the highest levels.
However as we all well know this is not an easy matter as the issue is
politically sensitive (promotion for screening) and has been blown out off
all proportions by our news media.
With respect to the "age-specific ref ranges" quoted, I share similar
concerns - WHERE DO THEY COME FROM? If we are to use them, they should
relate to those determined from clinical studies, and include ethnic ref
values, if revelant. The levels I have gleaned from the literature (and
used by many) and suggested for our reporting in the Caucasian population
are: age 40-49: <2.5, 50-59: <3.5, 60-69: <4.5, 70-79: <6.5. By no means
would I suggest that these be used as a "cast-in-stone" parameter, as I
believe that the urologist is in the best position to put all the pieces of
the puzzle together. In that vain we also offer "free PSA" and calc. of
free/total PSA but this is resticted to our urologists.
I hope this perspective is useful, and would be very interested to hear
others take on this.
Tom Dembinski PhD FCACB DABCC
Clinical Biochemist
Dept. of Clinical Chemistry
Health Sciences Centre
Room MS-543G, 820 Sherbrook Street
Winnipeg, Manitoba, R3A 1R9
CANADA
Tel. 204-787-4531
Fax. 204-787-3846
email: [log in to unmask]
-----Original Message-----
From: Dr S Walker [mailto:[log in to unmask]]
Sent: Tuesday, October 08, 2002 11:07 AM
To: [log in to unmask]
Subject: Prostate Cancer Risk Management Programme
I received a letter from the DoH on 30.09.02 stating that every GP in
England had been sent a resource pack (on 23.09.02) to help them in
counselling asymptomatic men requesting serum PSA testing. They also kindly
supplied me with one of the resource packs. The info gives empirical serum
PSA cut-offs for referral to urologists and these are lower than my current
age-related referent ranges (particularly for the 70 and overs). I
contacted our urologists, radiologists and histopathologists - none had been
sent this info or knew about this government initiative. We are not aware
of ANY extra funding to support the initiative either. Is anyone else? The
ACB mailbase has had nothing on this. Is everyone aware of this?! I've been
away on leave for some weeks so perhaps I missed all the debate? Is every
english lab changing to the stated cut-offs immediately?
These are:- age 50-59 PSA 3.0 ug/L or higher, age 60-69 PSA 4.0 or higher
and age 70 or above PSA 5.1 or higher. I guess that if you are currently
using a single cut-off of PSA 4.0, you and your colleagues will not see an
increase (maybe even see a fall) but we will see potentially an increase of
some 340 referrals/biopsies/follow ups p.a. My own workload wont'
really be affected but joined up NHS and sharing of information would be
nice! The letter also stated that by 31.03.03 laboratories will be using an
assay with calibration traceable to the 1st IRP for PSA andhaving equimolar
recognition of both free and complexed PSA. Interested to hear anyone else's
views. Dr Sue Walker, Laboratory Medicine, Salisbury District Hospital,
UK, SP2 8BJ
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Please note, archived messages are public and can be viewed
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