Prostate cancer testing decision support tool for patients and their families

Discussing testing and examination for prostate cancer can be challenging

Discussing the pros and cons of prostate cancer testing within a consultation can be challenging. New Zealand men currently receive conflicting advice about prostate cancer testing and treatment, with data showing test rates varying widely from practice to practice.

Guidelines recommend discussing the benefits and risks before testing

Guidance from the Prostate Cancer Working Group and the Ministry of Health recommends that when a man aged 50 to 70 years (or over 40 years with a family history of prostate cancer) presents with prostate-related concerns, General Practitioners should obtain informed consent before testing by discussing the benefits, risks and implications of testing for prostate cancer (Figure 1).¹

Figure 1: Recommended management for men presenting with prostate-related concerns. Adapted from the Ministry of Health¹

* Abnormal PSA levels by age:

• Aged ≤ 70 years: PSA ≥ 4.0 micrograms/L
• Aged 71-75 years: PSA ≥ 10.0 micrograms/L
• Aged ≥ 76 years: PSA ≥ 20.0 micrograms/L

† Red flags:

• Acute neurological symptoms
• Renal failure
• Bone pain
• Macroscopic haematuria (without UTI)

Kupe can help patients to make an informed decision

To help General Practitioners discuss the benefits, risks and implications of testing for prostate cancer with patients, bpac^nz, Homecare Medical and the Ministry of Heath have developed a decision support tool targeted at men and their whānau: Kupe. The tool provides information on the pros and cons of testing and guides men through a brief decision process designed to help them decide whether getting a prostate specific antigen (PSA) test and/or digital rectal examination (DRE) is right for them. Kupe can therefore assist with obtaining informed consent before PSA testing or conducted a DRE, and provide men and their whānau with relevant information should they later be referred to urology services (Figure 1).

Kupe is freely available at: https://www.kupe.net.nz/, and also accessible from an icon on your Medtech tool bar.

Kupe will be complemented by an upcoming decision support tool for clinicians

In June, bpac^nz will be releasing a decision support tool for GPs to support prostate cancer referral and management.