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Evidence for ImpActing

PSA and bone scans

As well as highlighting the unsung heroines and heroes in the NHS who are doing superb work in finding ways of improving quality of care and using evidence, often at reduced cost, ImpAct wants to find examples where getting evidence into practice is, or should be, a 'no-brainer'. These will be where evidence is good, and where the questions should be 'are we doing this', and 'if not, why not'.

PSA and bone scans

There are a number of studies showing that use of PSA serum tests can predict the results of a bone scan to investigate whether a patient has bone metastases. A PSA test costs about £10, the bone scan costs hundreds, and is unpleasant. The Figure shows that people with PSA values of less than 20 μg/L do not have bone metastases. The Figure shows that from two studies fewer than 1% of patients with values less than 20 μg/L have metastases.

Bandolier has two articles on this, one from the UK (Bandolier 47), and one from the USA (Bandolier 2), which give a lead into this important evidence. There are other positive articles in the literature to support this.


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