The Use and Misuse of the PSA Test: A Retrospective Case Note Review of Testing in a UK Teaching Hospital

Abstract

Introduction: PSA testing is commonly performed by non-urological specialties in the hospital setting. The indications for requesting a PSA test can vary widely in this group and may not always be appropriate. This may generate unnecessary patient anxiety and additional testing. This study was designed to assess the appropriateness of PSA requests by non-urologists in the hospital setting. Methods: A computer search for patient details of all PSA requests within a 3 month period by non-urologists was generated by the pathology department. 130 consecutive case notes were then reviewed of which 95 met the inclusion criteria. The reason for each request was then determined to be appropriate or inappropriate according to standard urological practice. Results: 95 patients were included. Of these, 61 (64%) requests were made by medical specialties, 17 (18%) were requested by orthopaedics, 12 (13%) by general surgery and the remaining 5 (5%) by other specialties. There were 26 (27%) requests deemed appropriate and 69 (73%) inappropriate. Of the inappropriate requests in 52 cases no reason was given, 14 were made immediately after acute urinary retention and 9 were during a suspected urinary infection. A rectal examination was performed in conjunction with the test in 24 cases. Conclusion: In this setting the majority of PSA requests made by non-urologists was inappropriate. This may be due to a lack of knowledge of the indication for PSA testing and the factors which may cause a false positive result. There was a low level of rectal examination. More education is needed to improve this situation.