162 © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 14 (2008) 162–164 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2006 The Authors; Journal compilation © 2006 Society/Blackwell Publishing Ltd2007141162164Original Article Prostate specific antigen test B. Zelhoff et al. RESEARCH LETTER Knowledge and utilization of prostate specific antigen test assay: a regional questionnaire study Bashar Zelhoff MRCS, 1 James Adam Forster MRCS, 2 Joby Taylor MRCS, 3 Anthony J. Browning MMed FRCSSA FRCS (Urol) 4 and Chandra Shekhar Biyani MS D Urol. FRCS (Urol) FEBU 4 1 Research Fellow, Department of Urology, Castle Hill Hospital, Hull, UK 2 Clinical Fellow, 3 Specialist Registrar, Department of Urology, St James’ University Hospital, Beckett Street, Leeds, LS7 9TF 4 Consultant Urologist, Department of Urology, Pinderfields General Hospital, Wakefield, UK To the Editor Awareness of prostate disease, in particular prostate cancer, has increased dramatically. The measurement of prostate specific anti- gen (PSA) has contributed to the startling increase in the number of cases of prostate cancer diagnosed in the late 1980s. On the other hand, it was soon recognized that although PSA alone was sensitive it lacked specificity. Concerns have been raised regarding the over- detection of incidental carcinoma with little malignant potential; PSA screening causes over-diagnosis rates of the disease in about 29% of white men and 44% of black men [1]. Despite the lack of evidence of the effectiveness of screening in reducing mortality from prostate cancer, increased testing for PSA has certainly con- tributed to the rising incidence of prostate cancer in the UK. The rate of PSA testing in 1999 was more than double the rate reported for 1994 [2]. Concerns about the workload and screening by PSA resulted in the development of the Prostate Cancer Risk Manage- ment Programme was launched in July 2001, with information available on the web. In September 2002, the risk management pack was distributed by the National Health Service (NHS) national screening office to every general practice in England and Wales. As abnormal PSA may require further investigations/treat- ments, which can cause significant morbidity, doctors should care- fully weigh their options and adequately counsel patients before PSA testing. Various guidelines therefore have been established to help clinicians regarding PSA test [3,4]. The purpose of this study was to assess the awareness of hospital doctors and general practi- tioners (GPs) of PSA and its guidelines, in order to improve the quality of PSA requests and reduce the workload and costs. Method We compiled a questionnaire. This asked: (1) What PSA stands for? (2) PSA secreted from? (3) What is the normal level (age- related) of PSA? (4) Non-malignant causes for rise in PSA; (5) Do you always do digital rectal examination (DRE) in conjunction with PSA request? (6) Prior to your request do you discuss about the test with patient? and (7) Are you aware of any guidelines regarding PSA test? A PSA questionnaire was mailed to 76 GPs in Wakefield region and was handed personally to most hospital doctors at all different grades in the relevant specialities by attending departmental meet- ings. Specialities included general surgery, general medicine, geri- atric, orthopaedics, and accident and emergency. We excluded hospital doctors from the Urology Department to prevent bias as they were aware of the audit methodology. All answers were entered as true/false or yes/no. Results were collected and analy- sed on the Microsoft Excel software. Answers were divided into two groups: GPs and hospital doctors (Table 1). We also contacted the Pathology Department to assess the total number of request and age distribution. A total of 141 questionnaires (response rate 87%) were obtained from different specialities. A total of 8350 PSA tests were requested in Pathology Department at the Mid-Yorkshire Hospitals NHS (Pinderfields and Pontefract) Trust between 1 January 2003 and 30 November 2003 and the cost of was £7932 (£94.4 per 100 tests). Interestingly, 123 (1.4%) tests were for men aged less than 35 years with the youngest being 17 years of age. Correspondence Mr Chandra Shekhar Biyani Department of Urology Pinderfields General Hospital Aberford Road Wakefield WF1 4DG UK E-mail: shekharbiyani@hotmail.com Accepted for publication: 27 July 2006