MRCGP SCA Consultation Skills Course
Station 12 · PSA result
Telephone consultation (audio only) · Investigations and results · Men's health · Older adults · Circuit 2 · 11:20–12:45 · 14-minute station
A 55-year-old rings for a PSA result he had 'for a work medical'; it is 5.6, his brother is incontinent after a prostatectomy, and he flies to his son's wedding in ten days.
Candidate brief
Read this as you would in the exam. One to two minutes' reading, then ten minutes. You may ask the patient for examination findings; there is no reference material.
| Patient | Ian Prescott, 55, airline ground operations manager. Telephone — results call-back: "PSA result" |
| PMH | Nil significant. Non-smoker. BMI 27 |
| Medication | None. Allergies: none |
| Recent entries | PSA 5.6 ng/mL (requested by a locum after the patient asked at a routine appointment; no symptoms recorded; no DRE recorded). U&E normal. No urine infection. Family history: brother — prostate cancer at 58, radical prostatectomy. Age-specific referral threshold (NICE NG12): 50–59 years, PSA above 3.5 |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (536 words)
Persona and manner
- Organised, brisk, used to managing logistics; wants facts and a timeline; hides anxiety behind questions about schedules. Sits in his car in a car park; occasional airport noise.
- Becomes quiet when his brother is mentioned.
Opening line — say this verbatim
- "Hello — I'm ringing for my PSA result. I only had it because my brother made me. I'm assuming it's fine? I'm flying to Perth for my son's wedding a week on Thursday, so if there's anything, I'd rather know now."
Volunteer freely if given the space
- No symptoms 'at all' — 'I'm fit, I run'.
- The wedding: son lives in Australia; three weeks away; 'non-negotiable'.
Only if asked
- Urinary symptoms on direct questioning: 'maybe I get up once at night — that's normal, isn't it?'; stream 'fine'; no blood; no pain; no bone pain; no weight loss.
- No recent urine infection, no catheter, no cycling before the test, no ejaculation within 48 hours — 'the nurse asked'.
- No DRE has ever been done — 'no thanks, not today' if it is proposed by phone, but he will agree to attend for one before or after the flight.
- Brother Neil: diagnosed at 58 two years ago; 'they took the whole thing out'; 'he wears pads, he can't… you know'; 'it's wrecked him'. Ian has decided he 'won't have that operation'.
- Father died at 80 of a stroke; no other cancer.
- Married; two sons; wife Julie 'will want to know everything'. He has not told her the test was done.
- He would rather have the referral 'after the wedding — I don't want it hanging over the trip', but if told two weeks matters, 'then get me in before'.
Ideas, concerns and expectations
- Idea: 'probably nothing — no symptoms'.
- Concern: 'ending up like Neil'; the trip being cancelled; telling Julie.
- Expectation: a normal result, or a plan that fits around the wedding.
Cues to deliver, timed
- Minute 1: 'I'm assuming it's fine?'
- Minute 3: 'it's wrecked him' — about the brother, if asked why the brother made him test.
- Minute 7: 'after the wedding, if possible.'
How to respond to the doctor's plan
- If the doctor gives the result clearly, explains what PSA does and does not mean (raised above the age threshold; a third to a half of men with this level do not have cancer; cancers found early are mostly treatable, often with surveillance), explains the suspected-cancer pathway and that the next step is an MRI before any biopsy (not straight to surgery), addresses the brother's story honestly (treatment is individualised; incontinence risk exists but is not inevitable; active surveillance is common), arranges DRE and referral now with a note about the travel dates so the MRI can be scheduled before or straight after, involves Julie as he wishes, and safety-nets: he exhales — 'so nobody's cutting anything out next week' — and asks the doctor to 'get the ball rolling, and I'll tell Julie tonight'.
- If the doctor says 'it's a bit high, we'll repeat it in three months': relieved — 'great, after the wedding then'; the examiner will not be.
- If the doctor says 'you need an urgent referral' with no explanation of the pathway: 'do I need to cancel the flight?' — and panic.
Do not
- Volunteer the nocturia, the brother's incontinence or the fact that Julie does not know unless asked.
- Agree to attend before the wedding unless told why it matters.
Mark scheme
Delegates: open after your consultation. Examiner-observers: open during it.
Generic mark scheme — identical at every station
Domain grades
| Domain | CF (0) | F (1) | P (2) | CP (3) | Points |
|---|---|---|---|---|---|
| Data Gathering and Diagnosis | ☐ | ☐ | ☐ | ☐ | /3 |
| Clinical Management and Medical Complexity (×1.5) | ☐ | ☐ | ☐ | ☐ | /4.5 |
| Relating to Others | ☐ | ☐ | ☐ | ☐ | /3 |
| Total | /10.5 |
Global rating: ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass (CF Clear Fail · F Fail · P Pass · CP Clear Pass)
Feedback statement(s) — tick the one (at most two) you would attach
| Domain 1 | Domain 2 | Domain 3 |
|---|---|---|
| ☐ 1.1 Insufficient data | ☐ 2.1 Referral | ☐ 3.1 Cues / listening / formulaic |
| ☐ 1.2 Notes not used | ☐ 2.2 Prescribing | ☐ 3.2 Agenda / beliefs |
| ☐ 1.3 Psychosocial | ☐ 2.3 Investigations | ☐ 3.3 Circumstances / culture |
| ☐ 1.4 Unsystematic | ☐ 2.4 Prevention | ☐ 3.4 Explanations |
| ☐ 1.5 Prioritisation | ☐ 2.5 Risk management | ☐ 3.5 Judgemental |
| ☐ 1.6 Implications of findings | ☐ 2.6 Co-morbidity | ☐ 3.6 Respect / sensitivity |
| ☐ 1.7 Differentials | ☐ 2.7 Uncertainty | ☐ 3.7 Ownership |
| ☐ 1.8 Diagnosis / decision | ☐ 2.8 Follow-up / safety-net | ☐ 3.8 Teamwork |
| ☐ 2.9 Time management | ☐ 3.9 Safeguarding |
Timing checkpoints (Observer)
| Checkpoint (10-minute frame) | Done | Minute |
|---|---|---|
| Patient allowed to open without interruption (≈1 min) | ☐ | |
| ICE and psychosocial context elicited by 3:30 | ☐ | |
| Red flags covered; examination findings requested by 5:00 | ☐ | |
| Working diagnosis verbalised; gear change by 5:00–5:30 | ☐ | |
| Options shared; patient's preference used | ☐ | |
| Specific safety-net and follow-up by 9:30 | ☐ | |
| Understanding checked; finished inside 10:00 | ☐ |
Key points for this station — customised standard
Key points for this station
| Domain | Pass requires | Clear Pass adds | Fail if |
|---|---|---|---|
| Data Gathering & Diagnosis |
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| Clinical Management & Medical Complexity |
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| Relating to Others |
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Global rating guide: Pass = result explained, referral criteria applied and acted on, the pathway (MRI-first) explained, the brother's story worked through, the wedding negotiated honestly.
Teaching points
- NICE NG12 (2021 update): refer on the suspected-cancer pathway if PSA is above the age-specific threshold (40–49: >2.5; 50–59: >3.5; 60–69: >4.5; 70–79: >6.5) — DRE is recommended but its absence should not delay referral; do not repeat the PSA if the man is asymptomatic and above threshold.
- NICE NG131: multiparametric MRI is the first investigation in the pathway; biopsy only if MRI Likert ≥3 or high suspicion; many low-risk cancers are managed by active surveillance.
- A family story of harm (the brother's incontinence) is the belief that will decide whether he attends: name it, answer it, and separate the referral from the operation.
Guidelines for this station
Your reflection
Record your grades, the statement attached, what you will keep and change, and your own reflection. Your entry is emailed to you as a record of this station; this page stays live so you can revisit the full case during revision.
Write my reflection for Station 12
Revision link for this case: mdacumen.com/sca-station12-psa-result
Editorial stamp · MRCGP SCA Consultation Skills Course · Station pages v1.0 · 11 September 2026 · Prof Rajesh Varma, Course Director · MD Acumen. Formative training material; not a prediction of exam performance. Not for onward distribution.