Contributors:
- Ailsa Ralph, senior clinical scientist, University Hospital Wishaw
- Johnathan Ho, clinical scientist, Nottingham University Hospitals NHS Trust
- Dawn Grenshaw, clinical scientist, Berkshire and Surrey Pathology Services
National Audit Day 2025, held on 28 November at the Royal College of Pathologists and online, brought together laboratory professionals from across the UK to explore how national audit findings can be used to reduce variation, improve consistency and strengthen patient-centred care. The meeting was opened by Dr Wassif Wassif, National Audit Lead, and focused on PSA, testosterone and tumour markers, combining national audit findings with expert clinical insight and patient experience to highlight both progress and ongoing challenges in laboratory medicine.
PSA testing: why context is critical
The national PSA audit was presented by Andrew Seggie and Abel Tesfai from Prostate Cancer UK, who explored how PSA is requested, analysed and reported across UK laboratories. While most laboratories now use NICE NG12 age-related thresholds, they highlighted that PSA requests frequently lack key clinical information such as prostate cancer history, treatment status or symptoms, limiting meaningful interpretation — particularly when PSA is used for monitoring rather than diagnosis.
This was followed by a clinical update from Professor Caroline Moore, who discussed current prostate cancer screening and diagnostic pathways, including emerging evidence from the TRANSFORM study. Her presentation reinforced the importance of close collaboration between laboratories and clinicians to ensure PSA results are interpreted in the correct clinical context.
The patient perspective: impact beyond the numbers
A powerful patient perspective was shared by Neil MacLachlan, a retired consultant obstetrician and gynaecologist, who described his experience of prostate cancer diagnosis, treatment and subsequent biochemical recurrence. He explained how a rising PSA following prostatectomy was initially reported as “normal” due to the application of a generic reference range, delaying recognition of recurrence until he reviewed the numerical results himself.
His account resonated strongly with the audience and reinforced a key message from the audit: PSA testing for detection and PSA monitoring following treatment are fundamentally different clinical questions and require different interpretative approaches.
PSA analysis and reporting limits
Variation in PSA analysis was further explored through audit findings and discussion. Laboratories reported using a range of analytical platforms, most commonly Roche, followed by Abbott and Siemens, with differences in recommended lower reporting and analytical limits.
Related findings from the national tumour marker audit were presented by Louise Ward (Bedford Hospital NHS Trust) and Peter West (South Thames Audit Group). They highlighted wide variation in PSA reporting limits at low concentrations and limited confirmation that these limits remain valid following verification. Speakers emphasised the importance of appropriate internal quality control material at low PSA concentrations and discussed whether harmonised or method-specific thresholds may be required to support reliable detection of biochemical recurrence.
Testosterone testing: variation and pathways
The national testosterone audit was presented by Nicola Barlow, who outlined significant variation in laboratory practice and a widespread lack of clear clinical pathways, with around 70% of laboratories reporting none in place. Inconsistent approaches to borderline male testosterone results, continued reporting of free androgen index in some laboratories, and limited communication of pre-analytical requirements for female testosterone testing were highlighted as key areas for improvement.
A clinical perspective was provided by Richard Quinton, who discussed testosterone therapy in pathological versus functional male hypogonadism. His presentation emphasised the importance of interpreting testosterone results within a broader clinical and physiological context and highlighted that testosterone replacement is not universally beneficial, with lifestyle interventions often more appropriate for certain patient groups.
Tumour markers: appropriate use and future direction
The tumour markers audit, the first national review since 2012, was presented by Peter West and Louise Ward, followed by an overview of tumour marker services from Cathie Sturgeon. Findings highlighted ongoing challenges around appropriate requesting, particularly in acute care settings, limited vetting of requests, and continued use of tumour markers in body fluids despite limited evidence and lack of external quality assurance.
There was strong support from both speakers and delegates for the development of a nationally agreed, LabMed-endorsed guidance document to bring together existing recommendations and support more consistent practice.
Looking ahead, Kathryn Hawkesford, Consultant Medical Oncologist at Barts Health NHS Trust, provided an overview of current and emerging cancer therapies, including CAR-T cell therapy and tumour-infiltrating lymphocytes. The scientific programme concluded with Professor Michael Duffy, who introduced circulating tumour DNA (ctDNA) and its potential role in cancer surveillance, recurrence detection and prognostic assessment.
Audit Award
As always, there was a very strong collection of posters on display. This year’s Audit Award was won by Hannah Fearon with “Rethinking Fixed Cutoffs in Prostate Cancer Screening”.
Runner-up was Megan Sounness with “Telephoning urgent cortisol results and the impact of an ONDST-cortisol test code “.
Conclusion
National Audit Day 2025 demonstrated the value of audit as a catalyst for reflection, discussion and change. Across all sessions, the message was clear: reducing unwarranted variation, embedding clinical context and improving communication are essential to ensuring laboratory results truly support patient care.