The Royal College of Pathologists of Australasia
Recommendations from The Royal College of Pathologists of Australasia about urinary tract infections, PSA testing, vitamin D deficiency screening, serum tumor marker tests and hyperlipidaemia. RCPA is the leading organisation representing pathologists and senior laboratory scientists in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.
Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
Prostate cancer causes significant mortality and morbidity and all patients with concerns about their risks of having the disease and/or their prognosis if diagnosed, including the role of prostate specific antigen (PSA) testing, should discuss these with their doctor.
Since any mortality benefit from early diagnosis of prostate cancer due to PSA testing is not seen within less than 6–7 years from testing, PSA testing is not recommended for men who are unlikely to live another 7 years.
- Bergdahl AG, Holmberg E, Moss S, et al. Incidence of prostate cancer after termination of screening in a population based randomised screening trial. Eur Urol 2013;64(5):703-9.
- Hugosson J, Carlsson S, Aus G et al. Mortality results from the Goteborg randomised population-based prostate-cancer screening trial. Lancet Oncol 2010;11(8):725-32.
- Roobol MJ, Kranse R, Bangma CH et al. Screening for prostate cancer: Results of the Rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol 2013;64(4):530-9.
- Schroder FH, Hugosson J, Roobol MJ et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366(11):981-90.
A list of ten items was compiled after reviewing international literature associated with the Choosing Wisely campaign in Northern America. The College’s advisory committees were canvassed for further relevant evidence based literature and their expert opinions were sought.
The ten items were then adopted as a College Position Statement titled ‘Inappropriate Pathology Requesting’. This list was then sent to RCPA Fellows and Trainees based in Australia to rank the top five tests to include in the Australian Choosing Wisely initiative. The five items selected were approved by both the RCPA's Board of Professional Practice and Quality and the RCPA Board of Directors.
- 1 Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
- 2 Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
- 3 Do not perform population based screening for Vitamin D deficiency.
Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers. There may be a role, however, for tumour marker measurement in the initial investigation and assessment of high risk or symptomatic individuals.
- 5 Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.