Cases/Renal and Urology

Man of 52 Requesting A Psa Test — Free SCA Practice Case

Man of 52 requesting a PSA test

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Duncan Hargreaves

Age

52 years

Consultation Type

Video

Age

Situation

Video Consultation.

Reason for Encounter

"I'd like a PSA test for prostate cancer, please. A close friend of mine has just died of it and I want to get checked."

Medical Records

●PMH: Nil significant.
●Medications: None.
●Allergies: NKDA.
●Recent notes: Nil. No previous PSA test recorded.

Patient Script

For the friend playing the patient role

Character Overview: You are Duncan, a 52-year-old quantity surveyor. A close friend died of prostate cancer three months ago, at 58 — it was advanced by the time it was found — and it has shaken you badly. You have no urinary or other symptoms whatsoever and feel completely well. You want a PSA blood test. You are also puzzled and a little indignant that there is no national screening programme for prostate cancer when there is for breast and bowel cancer, and you want that explained. You are reasonable and will listen, but if you feel you are being fobbed off or refused, you become insistent. If the doctor explains the pros and cons properly and offers you the choice, you will want to go ahead with the test.

Opening Sentence: "Hi Doctor. I'd like to have a PSA test, please. A good friend of mine died of prostate cancer three months ago — he was only 58 and by the time they found it, it was too late. It's really got to me. And honestly, I don't understand why there's no screening programme for it when there is for other cancers."

History if Asked (Data Gathering Phase)

●Why now: "My friend died three months ago. He was 58. It was advanced when they found it. It's shaken me up."
●His symptoms: "None at all. I feel completely well."
●His question: "Why isn't there a screening programme? There is for breast and bowel."
●What he wants: "I want the blood test — and to understand where I stand."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

●Ideas: Duncan believes a PSA test will tell him whether he has prostate cancer — he assumes it is a reliable screening test. "I assumed the blood test tells you whether you've got it or not."
●Concerns: His dominant concern is a grief-driven fear of dying of prostate cancer like his friend, and of it being found too late. "I'm frightened of the same thing happening to me — of it being found too late."
●Expectations: He expects to have the PSA test done. "I want the test doing."

If Asked — Symptom, Risk-Factor, and PSA-Confounder Screen

The patient answers these only when directly asked.

●If asked about lower urinary tract symptoms (poor stream, hesitancy, frequency, nocturia, urgency, incomplete emptying): "None of that — my waterworks are completely normal."
●If asked about visible haematuria or haematospermia: "No blood in my urine, and nothing like that."
●If asked about erectile dysfunction: "No problems there."
●If asked about bone pain, weight loss, or night sweats (constitutional/metastatic): "No pain anywhere, no weight loss, no sweats. I feel well."
●If asked about family history of prostate cancer: "My friend, but no blood relatives with it that I know of." (No first-degree family history.)
●If asked about ethnicity: "White British."
●If asked about recent ejaculation, vigorous exercise or cycling, urinary infection, or prostate procedures (PSA confounders): "I cycle to work most days, actually. No infections or procedures."
●If asked about his understanding of what happens after an abnormal PSA: "I hadn't really thought that far — more tests, I suppose? I hadn't considered a biopsy."
●If asked about how he is coping with the bereavement: "It's been hard, if I'm honest. He was a good friend and it's made me think about my own mortality."

Responses to Management (The Negotiation Phase)

●If the Doctor explains why there is no screening programme: "So the test isn't accurate enough — it misses cancers and flags things that were never going to cause harm? I hadn't understood that." (The tested point is explaining the absence of a screening programme accurately.)
●If the Doctor explains the downsides (false positives, overdiagnosis, biopsy risks): "So I could end up having a biopsy for something harmless, and biopsies have their own risks? That's worth knowing." (The tested point is balanced counselling on the harms.)
●If the Doctor explains the benefits and limitations honestly: "But it can also pick things up early, which is what I want. So it's a judgement call for me to make?" (The tested point is presenting benefits and limitations fairly.)
●If the Doctor offers him the test after counselling — key: "So it's my choice, and you'll do it if I want it? Yes — I'd like to go ahead." (The tested point is that after balanced counselling the informed patient's choice is respected — not gatekept.)
●If the Doctor mentions the examination and preparation: "You'd want to examine my prostate as well? And I should avoid cycling before the blood test?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Why There Is No Prostate-Cancer Screening Programme

●There is no UK national screening programme for prostate cancer because the PSA test performs poorly as a screening test: it misses some clinically significant cancers and detects many indolent cancers that would never have caused harm, so population screening has not been shown to do more good than harm.

Informed Choice, Not Gatekeeping — the Key Principle

●An asymptomatic man who requests a PSA test should receive balanced counselling on the benefits and harms; if he still wants the test, it should be offered. The clinician's role is to enable informed choice, not to refuse.

Counselling Content — Benefits and Harms

●Benefits: may detect cancer earlier, including treatable disease before symptoms.
●Harms: false positives leading to further investigation; overdiagnosis and overtreatment of cancers that would not have caused harm; false reassurance from a normal result; and the downstream pathway — MRI and possible biopsy, with biopsy risks including bleeding and infection.

Individual Risk Factors

●Risk is increased by age, Black ethnicity, and a first-degree family history of prostate cancer (and certain genetic factors) — these shift the balance of the discussion.

PSA Confounders and Preparation

●Recent ejaculation, vigorous exercise or cycling, urinary infection, prostatitis, digital rectal examination, and instrumentation/catheterisation can transiently raise the PSA. Advise appropriate avoidance beforehand and defer testing after infection, so the result is interpretable.

Interpreting and Acting on the Result

●Use age-related reference ranges; a raised PSA is not a diagnosis of cancer. Plan in advance what a normal, borderline, or raised result will mean — repeat testing and/or referral via the suspected-cancer pathway — and consider digital rectal examination (face to face, chaperone offered) as part of assessment.

Address the Person, Not Just the Test

●Acknowledge the bereavement or fear driving the request, offer support, consider a wider health check if wanted, document the balanced discussion and the patient's informed choice, and arrange follow-up.

Common Candidate Mistakes in This Case

●Gatekeeping: refusing a PSA test to an informed, asymptomatic man who wants one.
●Testing with no counselling: ordering the PSA without discussing the harms and the biopsy pathway.
●One-sided counselling: presenting only the harms (to dissuade) or only the benefits.
●Ignoring confounders: not advising on cycling/ejaculation/infection, producing an uninterpretable result.
●Missing the person: overlooking the bereavement, or failing to screen for symptoms and risk factors that would change the pathway entirely.

Free MRCGP SCA practice case for GP registrars covering Man of 52 Requesting A Psa Test — Renal and Urology. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

← Back to Free SCA Practice Cases