Intended for healthcare professionals


What should doctors say to men asking for a PSA test?

BMJ 2018; 362 doi: (Published 05 September 2018) Cite this as: BMJ 2018;362:k3702

Re: What should doctors say to men asking for a PSA test?

Thank you for a helpful editorial. But I was surprised at your statement that "some patients with aggressive prostate cancer have normal PSA levels. Therefore, testing should be accompanied by digital rectal examination" (DRE).

Efficacy of DRE in screening asymptomatic patients for prostate cancer has not been proven (Naji et al). DRE would not find deeper tumours. Even for superficial tumours reachable by DRE, there is a significant chance of false negatives, due to differences in examiners' ability to detect abnormalities, their technique and not least in the length of their index fingers. Additionally, mandating DRE might be counter-productive, as it may deter some men from seeking advice on prostate screening.

It might be better to recommend DRE as an option, rather than as a mandatory part of screening.

Reference: Naji L et al, Ann Fam Med March/April 2018 vol. 16 no. 2 149-154 (doi: 10.1370/afm.2205)

Competing interests: No competing interests

29 September 2018
David Spitzer
PHGH Doctors, Temple Fortune Medical Centre, Temple Fortune Lane, London NW11