Age-specific PSA thresholds for prostate cancer referral

What is it about?

The National Institute for Clinical Excellence (NICE) updated its guidance for prostate cancer referrals in 2021, recommending age-specific PSA reference ranges for referral. A database of 4100 patients from the Imperial/RM Partners Rapid Access Prostate Imaging and Diagnosis Online (RAPIDOnline) project was analyzed to model the effects of these changes on PSA referral thresholds. The results showed that as the age-specific threshold rises, the number of missed clinically significant prostate cancers (csPCa) increases, while the potential for biopsy avoidance rises with the NICE PSA thresholds. However, there is little effect on avoiding diagnoses of insignificant cancer. One in ten "missed" patients had locally advanced disease at referral, and the PSA or its kinetics may not be relied upon to raise and prompt a subsequent referral to secondary care. The authors recommend maintaining lower PSA referral levels. In a separate article, the impact of intra-operative neurovascular structure-adjacent frozen-section examination (NeuroSAFE) in radical prostatectomy (RP) on nerve-sparing surgery and early oncological outcome was examined in a large RP cohort. The results were encouraging but should be interpreted with caution due to differences in pathological assessment, imbalance of prognostic factors, and lack of predefined indications for NSS and non-NSS in the control group.

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Why is it important?

This research is important because it provides valuable insights into the potential impact of updated referral criteria for prostate cancer, as recommended by the National Institute for Clinical Excellence (NICE). The study uses real-world data from the Imperial/RM Partners Rapid Access Prostate Imaging and Diagnosis Online (RAPIDOnline) project to estimate the effects of changes in PSA referral thresholds on the diagnosis and treatment of prostate cancer. Key Takeaways: 1. The study found that the NICE age-specific PSA referral criteria could lead to a significant increase in the number of men who would not be referred for further testing, potentially missing clinically significant prostate cancer cases. 2. The study highlights the need for a more reliable screening program to detect prostate cancer cases that may be missed under the new referral criteria. 3. The research emphasizes the importance of maintaining lower PSA referral levels to ensure early detection and appropriate treatment of prostate cancer.