Prostate-specific antigen testing and opportunistic prostate cancer screening — informed consent

This is a comprehensive and well-researched project on the uptake and access of prostate cancer screening.¹ The authors correctly characterise the transition into a ‘post-trial world’ as the trend of prostate screening research is moving away from prostate-specific antigen (PSA) testing. However, at the time of writing the PSA test remains the primary screening modality for prostate cancer available to GPs.

For me, an aspect of PSA screening that still raises confusion for clinicians and patients is what constitutes informed consent. As mentioned in the article, current National Institute for Health and Care Excellence guidance suggests men may opt in to screening through shared decision making with their GP. The authors defined opportunistic PSA testing as testing performed on individuals without urinary symptoms. I am curious about the authors’ views on how to communicate information on opportunistic PSA testing to men in the primary care setting. There is mention in the article that the status quo is informal, with testing based on clinical suspicion and risk factors. However, as shown by the data, PSA testing uptake is subject to significant variation based on demographic factors.

As far as I am aware there is no standardised process informing men of the opt-in nature of PSA testing. Furthermore, there is an ethical dilemma over whether practices should proactively inform men of the option for PSA testing. If an informed, shared decision-making approach is best practice, should all men beyond a specified age be informed of opt-in PSA screening? On the other hand, it could be argued that a proactive approach to shared decision making is simply a form of PSA screening with an additional step.

• © British Journal of General Practice 2021