Prostate cancer (PC) is the most common type of cancer among men in Denmark with an
incidence of approximately 4.500 cases and 1.300 deaths every year. Usually prostate
cancer develops very slowly and men with a detectable prostate tumor can live for many
years without experiencing any symptoms. Autopsy studies of males who died of other
causes finds PC in approximately 30 percent of males in their fifties and up to 70
percent of males in their seventies. From that perspective most men die with prostate
cancer than because of it.
In Denmark the first examinations of a possible prostate cancer diagnosis take place in
general practice. Every citizen in Denmark with a social security number has free and
direct access to a general practitioner (GP) and works as a gatekeeper to the healthcare
system. If the GP suspects prostate cancer in a patient the GP has the possibility to
measure the level of prostate specific antigen (PSA) in a blood sample. If the level of
PSA is high it may indicate the presence of prostate cancer.
However, according to the national clinical guidelines on detection and diagnostic
investigation of prostate cancer the PSA-test is only recommended on a small patient
group with very specific and rare symptoms. Furthermore they do not recommend neither
systematic nor opportunistic screening with the PSA-test.
The reason for the rather restrictive guidelines for PSA-testing is to avoid
overdiagnosis and overtreatment of prostate cancer. A high level of PSA in a blood sample
is not necessarily due to prostate cancer but could also be elevated by other conditions
such as cystitis or an enlarged benign prostate. Even if the further examinations at a
urology department in a hospital finds prostate cancer in the patient it is potentially
indolent cancer and not a clinically important tumor which is an prostate cancer
overdiagnosis and could lead to unnecessary treatment which is overtreatment. The
treatment of prostate cancer could cause harms such as impotence, incontinence and faecal
incontinence.
Since 2018, GP's in Denmark has been encouraged to cluster in groups of other GP's from
their local area to work with quality development and form so called quality clusters.
The aim of these quality clusters was to create a medical professional forum where the
GP's could meet 2-4 times a year and exchange experiences with each other in a specific
clinically relevant area decided by the cluster itself. One of the main points of the
quality cluster concept was that the quality development work should be based on
descriptive data from their own GP clinics. At present 116 quality clusters exist in
Denmark and includes 3.519 GP's in 1.542 GP clinics.
By the same time of the establishment of the quality cluster a national organization
called KiAP (a Danish acronym for Quality in General Practice) was founded. The primary
purpose was to support the quality clusters with their quality development work. One of
the supportive initiatives by KiAP is the development of cluster packages which is
meeting material for the quality clusters on their cluster meetings. A cluster packages
has one specific clinically relevant theme and consists of data, expert videos,
reflection questions among other things.
The investigators have chosen to develop a cluster package about PSA-tests in general
practice with the purpose to promote an evidence-based practice. A pilot study will be
conducted in the development process. The aim of the study is to evaluate the
effectiveness of the cluster package. Since the study is a cluster randomized trial the
investigators invited all the Danish quality clusters to agree to use the cluster package
on one of their cluster meetings. The participating quality clusters are randomized to an
intervention group and a control group.