1. Methods Three questionnaires were designed with reference to national guidelines and the PCRMP’s recommendations. These questionnaires were sent to PCTs, Lead Urologists and SWPHO Urology Tumour Panel contacts and laboratories of clinical biochemistry at Hospital Trusts across the five Cancer Networks contributing to the SWCIS region – Avon, Somerset and Wiltshire Cancer Services (ASWCS), Dorset, Central South Coast and Three Counties (3 Counties). SURVEYS OF POLICIES AND PRACTICES FOR PROSTATE CANCER IN SOUTH WEST ENGLAND South West Cancer Intelligence Service www.swpho.nhs.uk K Ruth 1 (kate.ruth@swpho.nhs.uk), R Hancock 1, A Gjini 2, C Harling 2, T Cross 2, J Verne 1 1 Cancer Intelligence Service, South West Public Health Observatory 2 Formerly of the South West Public Health Observatory Background Previous work by the South West Public Health Observatory (SWPHO) found that the incidence of prostate cancer increased from 1993–2002 in the South West of England, with differences in the incidence between Primary Care Trusts (PCTs). To investigate the reasons for this, surveys were conducted to gather data on prostate specific antigen (PSA) testing practices within the region. Questionnaires were designed with reference to national guidelines and the Prostate Cancer Risk Management Programme (PCRMP). Consultant urologists, PCTs and laboratories were surveyed across the five Cancer Networks in South West England. Some key guidelines [1–4]: PSA tests should be available on request to men over 50 years. Before having a PSA test, men should be provided with clear information about the test and the uncertainty about the balance of benefits and risks of screening for prostate cancer. A standardised follow-up pathway should be available for men who have a positive test. Response rate Responses for 19/45 PCTs. 15/34 urologists responded from 13 Trusts. 18 laboratories responded from 17/25 Trusts – 17/18 performed PSA testing. NetworkNumber of Trusts responding/ Number Trusts sent survey PCTsUrologistsLabs 3 Counties1/51/43/3 ASWCS5/124/115/7 (6 labs i ) CSC7/125/94/7 Dorset3/51/40/3 Peninsula3/114/65/5 i Two laboratories responded from one Trust. PCT survey Few PCTs had policies for prostate cancer: Laboratory survey (Data are for the 17 laboratories performing PSA testing.) 17/17 laboratories had a standard protocol for PSA testing and this agreed with the PCRMP for 16/17. From 2000–04 the number of PSA tests increased, as did the number of positive tests (see below). The proportion of tests in each age group was fairly constant. The proportion of tests that were positive was fairly constant. Overall, 70% of tests were for primary care (data for 15 laboratories, range 55–82%). Urologist survey 14/15 urologists responded that the number of patients referred to prostate cancer clinics had increased. This increase was thought mainly to be in asymptomatic patients (9/14) and due to increased PSA testing (14/14). 6/14 urologists had changed their practice to agree with the PCRMP. Responses indicated that most Network Urology SSGs had guidelines for prostate cancer: Within Networks, on the whole, urologists agreed that there were policies for PSA testing, but in two Networks there was disagreement. Network urology SSG guidelines/policies Responses (N=15) YesNoNo answer PSA testing1041 Diagnosis of suspected prostate cancer 1311 Referral of suspected prostate cancer 1401 Management of prostate cancer 1401 Data are for seven labs providing calendar year data by age group. PCT policy/ guidelines:Responses (N=19) YesNoDon’t know No answer PSA testing31141 Diagnosis of prostate cancer8731 Referral for prostate cancer9631 Conclusions Few PCTs reported policies for PSA testing – these may need to be developed. Within Networks, PCTs and urologists disagreed on whether there were SSG policies on PSA testing. This may require clarification. The PCRMP appeared to have had limited influence on PCTs’ and urologists’ policies/practices. There was an increase in the number of PSA tests and the number of positive PSA tests, however it was not possible to distinguish repeat tests (for example, for ‘watchful waiting’) from diagnostic tests. This work has prompted one Cancer Network to make sure that their policies are available on their web site. Total and positive PSA tests by age group. Network Urology SSG policies/guidelines for PSA testing: NetworkPCT responses (N=19)Urologist responses (N=15) YesNoDon’t know No answer YesNoNo answer 3 Counties0100100 ASWCS2120220 CSC0412500 Dorset2100100 Peninsula0111121 Total48431041 Responses from PCTs in the same Networks disagreed about whether there were Network Urology Site Specialist Group (SSG) PSA testing policies. PSA testing practices had changed since 2000 for 6/13 PCTs. 11/19 PCTs were aware of the PCRMP. The PCRMP influenced only 6/15 PCTs’ PSA testing policies. 9/19 PCTs responded that information was provided before PSA testing while 7/19 did not know. References 1.Prostate Cancer Risk Management Programme. Cancer Screening Programmes. http://cancerscreening.org.uk/prostate 2.Department of Health. The NHS Cancer Plan: Three year progress report. Maintaining the momentum. 2003 3.NICE. Guidance on Cancer Services. Improving Outcomes in Urological Cancers. The Manual. September 2002. 4.National Screening Committee Policy Position – Prostate Cancer Screening. March 2004. PSA testing [1]: can detect localised prostate cancer; is not diagnostic – a biopsy is required; does not distinguish between aggressive and slow growing tumours; may detect tumours that would not be clinically apparent during a man’s lifetime; up to 2/3 men with raised PSA will not have prostate cancer while 1/5 men with a normal PSA will have prostate cancer. Background on the PCRMP [1]: There is no UK screening programme for prostate cancer using PSA testing. The PCRMP is an informed choice programme introduced by the UK Government, which aims to ensure that men considering a PSA test are provided with clear, balanced information about the risks and benefits of PSA testing. GPs have been provided with information by PCRMP to aid with counselling men who are concerned about PSA testing. All PSA tests Positive (+ve) PSA tests Objectives To survey PSA testing practice in relation to PCRMP recommendations. To obtain laboratory data on the number of PSA tests carried out.