Excessive PSA testing in general practice

There is little doubt that Australian doctors order too many prostate-specific antigen (PSA) screening tests. The analysis by Franco and colleagues of electronic data for 142 000 Victorian general practice patients, published in this issue of the MJA, found that 46% of men aged 70–74 years had had at least two PSA tests during the preceding two years,1 despite Australian guidelines recommending against PSA screening of asymptomatic men in this age group.2 Indeed, the Royal Australian College of General Practitioners (RACGP) does not recommend PSA screening of most asymptomatic men of any age.3 Some testing might be justified (for example, screening of men at high risk, or prostate disease monitoring), but when Australian general practitioner registrars were asked to record specific reasons for ordering PSA tests, “asymptomatic screening” accounted for three-quarters of requests.4