Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review

<p>Abstract</p> <p>Background</p> <p>Prostate specific antigen (PSA) testing is widely used, but guidelines on follow-up are unclear.</p> <p>Methods</p> <p>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.</p> <p><it>Data sources</it>. MEDLINE, Embase, PsychInfo and the Cochrane library from January 1950 until May 2011.</p> <p><it>Study eligibility criteria</it>. 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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p