Tumour marker – short life working group
SCBMDN is setting up a short life working group which has the remit of reducing inappropriate requesting and encouraging improved quality and consistency of tumour marker services in Scotland.
The group aims to:
- foster links between laboratory representatives and the organ specific groups within each of the three regional cancer networks (WOSCAN, NOSCAN, and SCAN)
- consider areas which would benefit most from closer collaboration (e.g., development of guidance relevant to measurement of CA19-9, adoption of age related cut-offs for PSA)
Tumour marker requesting bookmark
The Scottish Clinical Biochemistry Managed Diagnostic Network (SCBMDN) has been involved with Pathology Harmony (UK) in developing guidance about the appropriate use of commonly requested serum tumour markers.
Intended as an aide-memoire for primary care (and others), this guidance is now available in the form of a bookmark. The bookmark has the support of the Royal College of Pathologists, the Association for Clinical Biochemistry and the Institute of Biomedical Science and has been peer reviewed by a number of clinicians and laboratory scientists. Distribution of the bookmark is supported by the Detect Cancer Early Taskforce and the Scottish Primary Care Cancer Group, who have agreed that it is a helpful tool which should be made widely available.
The bookmark is sized to fit within printed copies of the British National Formulary, and electronic versions are planned in the future. Ready availability of this information should help to reduce variability in tumour marker requesting practice across Scotland.
Prostate Specific Antigen (PSA)
PSA is a protein produced mainly by cells in the prostate gland and can be a useful indicator of prostate cancer. This protein can be found in all males; however, men whose levels are increased may have an infection of the prostate gland (prostatitis), prostate enlargement or prostate cancer.
Because PSA concentrations increase with age, Scottish Referral Guidelines for Suspected Cancer (HDL(2007)9) recommend the use of age related reference ranges for PSA to determine which patients should be referred for further investigation (e.g. 50-59 years ≤3.0 ng/mL; 60-69 years ≤4.0 ng/mL; ≥70 years ≤5.0 ng/mL.) These age related cut offs are also quoted by the NHS Prostate Cancer Risk Management Programme.
Currently some Scottish Biochemistry laboratories report a single reference range for PSA, while others report age related ranges.
SCBMDN proposes that all Health Boards consider adoption of age related cut offs for PSA if not currently doing so.