title: Unravelling the prostate-specific antigen controversy: a West of Scotland perspective.
abstract: BACKGROUND
  The use of serum prostate-specific antigen (PSA) as a screening tool for prostate cancer in asymptomatic men is hugely controversial in the light of randomised controlled trials failing to demonstrate a benefit without risk of significant overtreatment. However, PSA can be used as a tool to risk assess disease progression in men with lower urinary tract symptoms suggestive of benign prostatic enlargement (LUTS/BPE). The aim of this study was to canvas the opinions of West of Scotland Urologists regarding the use of PSA in both symptomatic and asymptomatic patients.
  
  
  METHODS
  A questionnaire-based survey was sent to all the Consultants and Trainees in the West of Scotland.
  
  
  RESULTS
  Survey response rate was 45% (47/105). In patients <70 years, 93% would perform a PSA testing in patients symptomatic of LUTS/BPE, but only 17% would offer PSA screening to asymptomatic patients. In patients >70 years, only 48% of urologists would perform a PSA if patients were symptomatic and none would offer PSA screening. In terms of self-testing, 59% of urologists would have a PSA test if symptomatic and 31% of urologists would have PSA screening.
  
  
  CONCLUSIONS
  This study highlights significant variability in the use of PSA for both asymptomatic and symptomatic men. Despite a lack of evidence, PSA screening is still offered to asymptomatic men. Further randomised studies are required to determine the utility of PSA-based screening algorithms for prostate cancer detection.
authors.affiliation: Speciality Registrar in Urology, East Midlands Deanery, NHS England, UK.
authors.forename: Nauman
authors.initials: N
authors.lastname: Zafar
authors.forename: Steve
authors.initials: S
authors.lastname: Miller
authors.forename: Vicki
authors.initials: V
authors.lastname: Leburn
authors.forename: Khaver N
authors.initials: KN
authors.lastname: Qureshi
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Rajan
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000097:blood* / Q000209:etiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018570:Risk Assessment; D012606:Scotland; D011795:Surveys and Questionnaires; D014572:Urology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Prostate-specific Antigen; prostate cancer guidelines; prostate cancer screening; prostate cancer treatment