Supporting Clinical Decision-Making Beyond PSA

In Episode 1 of the Pathology News podcast series, the discussion centred on the challenges clinicians face when managing elevated PSA results and navigating the uncertainty of the PSA “decision zone”- the 2–10 ng/mL range where most men with elevated PSA land, and where clinical decision-making is hardest.

Episode 2 turns the focus towards potential solutions, exploring how additional risk stratification tools can support clinical decision-making, improve patient confidence, and help optimise prostate cancer pathways.

Hosted by Sidney Ocanagil-Tunstall, the discussion brings together Dr Asif Naseem, GP and specialist in preventative healthcare and men’s health, and Dr Beat Rheiner, CEO of Proteomedix, to examine how innovative diagnostics can complement existing pathways and provide greater clarity for both clinicians and patients.

Adding Confidence to Clinical Decisions

While PSA testing remains an important first-line tool, clinicians are often faced with difficult decisions when results fall within intermediate ranges. The challenge is knowing which patients need further investigation, and which can safely avoid unnecessary procedures.

The discussion explores how additional risk stratification tools can provide additional information to support these decisions, helping clinicians better assess an individual’s likelihood of having clinically significant prostate cancer.

For many patients, the prospect of a biopsy is daunting, and hesitancy around invasive procedures is a very real challenge clinicians face in practice. As Dr Naseem explained, having an additional risk stratification tool can be particularly valuable in these situations, providing a clearer picture of a patient’s individual risk before any decision about further investigation is made.

“Using Proclarix is useful in helping identify patients who may progress who are reluctant to go for biopsy testing.”

By providing additional information to support conversations around risk, clinicians can help patients make more informed decisions about their next steps.

Reducing Unnecessary Investigations

A recurring theme throughout the episode was the importance of avoiding unnecessary procedures while ensuring clinically significant cancers are not missed.

With up to 70–80% of elevated PSA results being false positives, a significant number of men are currently being referred for MRI or biopsy who may not require further investigation. Alongside the pressure this places on healthcare resources, unnecessary procedures carry inherent clinical risks, and the psychological burden of navigating diagnostic uncertainty can be difficult for patient.

The speakers discussed how additional risk stratification tools can help address this by providing a clearer picture of an individual patient’s risk profile before any decision about further investigation is made. For patients who are unlikely to have clinically significant cancer, this can mean avoiding procedures that offer little clinical benefit. For those who do require further investigation, it means reaching that point sooner, with greater confidence.

Education: The Key to Successful Implementation

The conversation also highlighted a common challenge associated with introducing innovative diagnostics into clinical practice.

New tests can only improve patient care if clinicians understand how and when to use them.

As Dr Naseem noted:

“We’re not training all our doctors, and I think that’s the important part, that actually we need to make results like this, tests like this, more accessible to other GPs so that it becomes more widely understood, utilised, and correctly used.”

The discussion emphasised that education is essential to successful implementation. Providing clinicians with the knowledge and confidence to interpret results appropriately is just as important as the technology itself.

Looking Ahead

The episode concludes by looking ahead, exploring where diagnostics in prostate cancer are heading, and the growing role of biomarkers and emerging technologies in enabling more personalised approaches to risk assessment and patient care.

While innovation continues to advance, the discussion makes one point clear: improving prostate cancer outcomes is not only about developing better tests. It is about ensuring those tests are understood, implemented effectively, and integrated into clinical pathways in ways that genuinely support patients and clinicians alike.

Watch Episode 2 of the Pathology News podcast to hear the full discussion.