Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review.
BACKGROUND
Prostate specific antigen (PSA) testing is widely used, but guidelines on follow-up are unclear.


METHODS
We performed a systematic review of the literature to determine follow-up policy after PSA testing by general practitioners (GPs) and non-urologic hospitalists, the use of a cut-off value for this policy, the reasons for repeating a PSA test after an initial normal result, the existence of a general cut-off value below which a PSA result is considered normal, and the time frame for repeating a test. Data sources. MEDLINE, Embase, PsychInfo and the Cochrane library from January 1950 until May 2011. Study eligibility criteria. Studies describing follow-up policy by GPs or non-urologic hospitalists after a primary PSA test, excluding urologists and patients with prostate cancer. Studies written in Dutch, English, French, German, Italian or Spanish were included. Excluded were studies describing follow-up policy by urologists and follow-up of patients with prostate cancer. The quality of each study was structurally assessed.


RESULTS
Fifteen articles met the inclusion criteria. Three studies were of high quality. Follow-up differed greatly both after a normal and an abnormal PSA test result. Only one study described the reasons for not performing follow-up after an abnormal PSA result.


CONCLUSIONS
Based on the available literature, we cannot adequately assess physicians' follow-up policy after a primary PSA test. Follow-up after a normal or raised PSA test by GPs and non-urologic hospitalists seems to a large extent not in accordance with the guidelines.
Isala clinics, Department of Urology, Zwolle, The Netherlands.
Saskia
S
Van der Meer
Sabine A M
SA
Löwik
Willem H
WH
Hirdes
Rien M
RM
Nijman
Klaas
K
Van der Meer
Josette E H M
JE
Hoekstra-Weebers
Marco H
MH
Blanker
D058006:General Practice; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D020445:Hospitalists / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012017:Referral and Consultation / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen