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.


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.

Date reviewed: 30 March 2022

The measurement of levels of certain tumour biomarkers is known to be helpful in monitoring the progress of specific cancers in response to treatment or in detecting changes in cancer activity or secondary or recurring cancer. In some circumstances they are helpful adjuncts in detecting specific cancers, where there is a strong known underlying predisposition or suspicion, such as in detecting liver cancer in patients with chronic hepatitis C and cirrhosis. However, the testing for a broad range of biomarkers in patients with non-specific symptoms in the hope of finding an undetected cancer is not supported by the evidence from numerous systematic reviews. Tumour markers generally should not be used in the initial diagnostic pathway and are rarely diagnostic due to low sensitivity and specificity.

Supporting evidence
How this list was made How this list was made

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.

Download RCPA Recommendations