Prostate-specific antigen testing: uncovering primary care influences

BJU Int. 2006 Nov;98(5):996-1000. doi: 10.1111/j.1464-410X.2006.06481.x.


Objectives: To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing.

Subjects and methods: In Northern Ireland in 2003-2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests).

Results: In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a 'well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21-30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels.

Conclusion: There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Attitude of Health Personnel
  • Family Practice / education
  • Family Practice / organization & administration*
  • Female
  • Humans
  • Male
  • Northern Ireland
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / diagnosis*
  • Surveys and Questionnaires


  • Prostate-Specific Antigen