PSA—to test or not

How should a man decide whether to have a PSA test? In the UK, routine testing isn’t offered, but men over 50 years old can request the test from their GP. Digital decision aids abound, but do they help men to reach a decision compared with usual care (discussing the pros and cons with a doctor)?

This systematic review and meta-analysis of 19 randomised clinical trials comparing decision aids for prostate cancer screening in 12 781 men found that decision aids are probably associated with a small reduction in “decisional conflict,” possibly associated with an increase in knowledge and possibly not associated with whether physicians and patients discuss prostate cancer screening or what screening decision the man makes.

PSA is an imperfect test, and no amount of shared decision making can get round that.