PSA (prostate-specific antigen) follow-up monitoring (Guidelines)

Patient group

Proposed PSA monitoring 

(as per Service Agreement)

Patients with confirmed high grade PIN (prostatic intraepithelial neoplasia) on biopsy (this can be a pre-cursor for prostate cancer)

• PSA testing in primary care: 6 monthly for 2 years then annually thereafter, if PSA stable

• If 1 x rise, repeat in 3 months and if 2 x sustained rises above baseline, please re-refer

• If DRE done and any changes or concerns, please re-refer

Patients who have had a prostate biopsy that was negative for malignancy

• PSA testing in primary care: 6 monthly for 2 years

• If 1 x rise, repeat in 3 months and if 2 x sustained rises above baseline, please re-refer

• If patient wishes to continue PSA monitoring after the 2 year period, this would be decided between the GP and the patient, and annual testing would be reasonable. This would be outwith this SLA, ie, remove code for this patient

• If DRE done and any changes or concerns, please re-refer

Patient opts to continue PSA monitoring after prostate assessment clinic having been offered MRI +/- biopsy

• 3 monthly PSA testing for 1 year under care of urology with phlebotomy requested through ITR (no code under SLA). At the end of 1 year urology will discharge for PSA testing in primary care 6 monthly for a further 2 years

• If 1 x rise, repeat in 3 months and if 2 x sustained rises above baseline or if patient now wishes investigation, please re-refer

• If patient wishes to continue PSA monitoring after the 2 year period, this would be decided between the GP and the patient, and annual testing would be reasonable. This would be outwith this SLA, ie, remove code for this patient

• If DRE done and any changes or concerns, please re-refer

Patients who have had a normal MRI after prostate assessment

• PSA testing in primary care: 6 monthly for 2 years

• If 1 x rise, repeat in 3 months and if 2 x sustained rises above baseline, please re-refer

• If patient wishes to continue PSA monitoring after the 2 year period, this would be decided between the GP and the patient, and annual testing would be reasonable. This would be outwith this SLA, ie, remove code for this patient.

• If DRE done and any changes or concerns, please re-refer

Watchful Waiting (WW): Patients who have been discharged to Primary Care on watchful waiting 

• PSA testing in primary care: 6 monthly

• Re-refer if PSA doubles from time of last staging or start of WW or signs/symptoms of metastatic disease.

Watchful waiting is usually offered to patients who are unlikely to benefit from radical treatment but where ongoing monitoring is recommended. (Non curative treatment may be commenced if disease progresses to metastases.)

Metastatic prostate cancer (not on second line therapy i.e on long term LHRH only)

• PSA testing in primary care with PSA testing at time of LHRH injection

• Re-refer if 2 x successive rises from time of last staging. Prior to referral please check early morning testosterone to ensure patient is castrate. If patient is not castrate then they may have missed an injection.

NB: When patients are re-referred they will likely be restaged and may be offered additional treatment.