BACKGROUND: Worldwide, the use of prostate specific antigen (PSA) testing as a 
screen for prostate cancer is contentious. Whilst there is no National UK 
Screening programme, many men undergo opportunistic screening. This study 
investigates UK urologist's usage of PSA and the awareness surrounding the 
Department of Health (DoH) PSA guidelines.
METHODS: Urologists were sent a questionnaire regarding PSA cut-off values.
RESULTS: Of the 733 urologists eligible to participate in this study 346 
returned completed questionnaires giving a response rate of 47%. The most 
commonly generally used age-related PSA cut-off values (36% of respondents) 
are--3.5 ng/ml for 50 - 59 year olds, 4.5 ng/ml for 60 - 69 year olds and 6.5 
ng/ml for over 70 year olds. Two-thirds (58%, 200/346) of respondents were aware 
of the DoH PSA guidelines but only 20% (n = 69/346) follow these guidelines. The 
majority of respondents (68%, n = 234/346) used higher PSA cut-offs than 
recommended by the DoH. The level of compliance showed marked regional variation 
with a range from 7% to 44% (median 19%). In addition, it was apparent that 
lower PSA cut-off values were used in private practice as opposed to the 
National Health Service.
CONCLUSION: A nationwide lack of agreement on PSA cut-off values may generate a 
variable standard of care both regionally and in NHS versus private practice. 
Generally, higher PSA cut-off values are being used than recommended by the DoH 
guidance.