BACKGROUND: Increased use of prostate specific antigen (PSA) has been associated 
with increased prostate cancer incidence. Ireland is estimated to have one of 
the highest prostate cancer incidences in Europe and has no national guidelines 
for prostate cancer screening. GPs have a pivotal role in influencing PSA 
testing, therefore, our aim was to describe GP testing practices and to identify 
factors influencing these.
METHODS: A postal survey, including questions on clinical practice and 
experience, knowledge and demographics was distributed to all GPs (n = 3,683). 
The main outcomes were (i) PSA testing asymptomatic men and (ii) "inappropriate" 
PSA testing, defined as testing asymptomatic men aged < 50 or > 75 years. 
Factors associated with these outcomes were identified using logistic 
regression.
RESULTS: 1,625 GPs responded (response rate corrected for eligibility = 53%). 
Most respondents (79%) would PSA test asymptomatic men. Of these, 34% and 51% 
would test asymptomatic men < 50 and > 75 years, respectively. In multivariate 
analyses, GPs were more likely to test asymptomatic men if they were >or= 50 
years, in practice >or= 10 years, female or less knowledgeable about PSA 
efficacy. Male GPs who would have a PSA test themselves were > 8-times more 
likely to PSA test asymptomatic men than GPs who would not have a test. GPs who 
had an asymptomatic patient diagnosed with prostate cancer following PSA 
testing, were > 3-times more likely to test asymptomatic men. Practice-related 
factors positively associated with testing included: running 'well man' clinics, 
performing occupational health checks and performing other tests routinely with 
PSA. Factors positively associated with 'inappropriate' testing included; being 
male and willing to have a PSA test, having worked/trained in the UK and 
supporting annual PSA testing. 91% of respondents supported the development of 
national PSA testing guidelines.
CONCLUSION: Our findings suggest that widespread PSA testing of asymptomatic men 
in primary care is primarily due to a combination of clinical experience, poor 
knowledge and the support of doctors for PSA testing, as evidenced by the 
willingness of male doctors to have a PSA test. There is an urgent need for 
education and support for GPs concerning prostate cancer screening, starting 
with the implementation of national guidelines.