The routine use of digital rectal examination (DRE) and prostate specific antigen (PSA) as early detection tests to facilitate the early diagnosis of prostate cancer among asymptomatic men remains controversial. (1,2) The Royal Australian College of General Practitioners guidelines on the management of prostate cancer at the primary care level (3) contain no advice on how GPs should manage individual men who ask to be tested for the disease.
A low baseline level of PSA is a good predictor of future low levels, and is in itself associated with low risk of developing prostate cancer. Men with levels below 1.0 ng/mL are 5-6 times less likely to be diagnosed with prostate cancer in the succeeding 10 years than men with levels between 2.0 and 3.0 ng/mL. (4) A PSA test interval of 2 years with a baseline PSA level below 2.0 ng/mL is unlikely to fail to detect any prostate cancers. (5)