GP Vivas · mens-health
PSA testing and prostate cancer — structured viva
Structured oral on PSA testing: defending informed choice with ERSPC numbers, handling the elevated-PSA consultation, arguing MRI-before-biopsy from PROMIS and STHLM3MRI, explaining grade groups and surveillance, and closing on ProtecT's trade-off counselling.
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Prompt
The examiner opens: 'Your patient's PSA is 5.2 ng/mL. He has read that screening kills more men than it saves, and his brother says a scan saved his life. Take me through your consultation.' The viva branches through informed choice, evidence interpretation, risk adaptation, MRI and biopsy, grading and surveillance, and treatment trade-offs.
Stem
You are the GP. The number on the screen is 5.2 ng/mL; the man in front of you has two conflicting narratives in his head. [19]
References14ShowHide
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- [6]Donovan JL, Hamdy FC, Lane JA et al. Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment. NEJM evidence, 2023.PMID 38320051
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- [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
- [10]Vale CL, Fisher D, Kneebone A et al. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet, 2020.PMID 33002431
- [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
- [20]Magi-Galluzzi C, Montironi R, Epstein JI Contemporary Gleason grading and novel Grade Groups in clinical practice. Current opinion in urology, 2016.PMID 27308734
- [21]García-Fuentes C, Hernández V, Jiménez-Alcaide E et al. Active Surveillance as Preferred Treatment for ISUP Grade I Prostate Cancer: Confronting the ProtecT Trial. Archivos españoles de urología, 2024.PMID 39632514