GP CCE Cases · mens-health
Elevated PSA — CCE clinical encounter
CCE-style clinical encounter: a 62-year-old returns for a raised PSA result, frightened by his brother's death and bombarded by internet extremes. The candidate must deliver informed reassessment, order the right workup, discuss MRI triage, and keep shared decision-making alive through fear.
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Study tools
Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 62-year-old retired electrician attends after a PSA of 5.2 ng/mL done at a health expo. His younger brother died of prostate cancer two years ago at 58. He has read online that 'PSA testing is a scam' but also that 'every man should be scanned'. He has mild urinary hesitancy, no bone pain, no weight loss. He says: 'Just tell me — do I have cancer?'
Objectives
- Address the emotional agenda (grief for his brother, fear) before the biomedical one. [17]
- Explain what a single elevated PSA does and does not mean, using absolute numbers. [1] [15]
- Complete structured reassessment: repeat PSA, DRE, urinary assessment, risk history. [16]
- Discuss multiparametric MRI as triage with honest performance data. [7] [8]
- Agree a documented plan and follow-up interval without closing down his autonomy. [15]
References8ShowHide
- [1]Roobol MJ, de Vos II, Månsson M et al. European Study of Prostate Cancer Screening - 23-Year Follow-up. The New England journal of medicine, 2025.PMID 41160819
- [7]Ahmed HU, El-Shater Bosaily A, Brown LC et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet, 2017.PMID 28110982
- [8]Hugosson J, Månsson M, Wallström J et al. Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only. The New England journal of medicine, 2022.PMID 36477032
- [14]Brentnall AR, Rebolj M, Sasieni P et al. Evaluating the Impact of Age on Prostate Cancer Overdiagnosis Using Long-Term Follow-Up From the CAP Randomised Trial. International journal of cancer, 2026.PMID 42015666
- [15]Remmers S, Bangma CH, Godtman RA et al. Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer. European urology, 2023.PMID 37088597
- [16]Cirulli GO, Davis M, Stephens A et al. Midlife baseline prostate-specific antigen, velocity, and doubling time association with lethal prostate cancer and mortality. Cancer, 2025.PMID 39377255
- [17]Sheikh SR, Castanon A, Mathews C et al. Association of asymptomatic PSA testing on prostate cancer mortality; a case control study in general practice. BJGP open, 2026.PMID 42320978
- [19]Wei JT, Barocas D, Carlsson S et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. The Journal of urology, 2023.PMID 37096582