Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

Abstract

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62–69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02–1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67–0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

Significantly reduced incidence and improved survival from prostate cancer over 25 years

“…Early detection is based on the use of a prostate specific antigen (PSA), which is controversial since it leads to an overdiagnosis of indolent cancers [ 6 ]. In fact, it has been estimated that up to 35% of the PSA tests performed do not comply with the recommendations of clinical guidelines [ 7 ]. Current worldwide guidelines recommend that men receive a PSA test following a comprehensive shared decision-making process after informing them of the advantages, disadvantages and uncertainties regarding the test [ 8 ].…”

PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study

“…Moreover, most of the available data derives from clinical trials with high-risk populations, which differ quite significantly from the unselected population undergoing opportunistic screening in clinical practice. Our group has previously evaluated those factors associated with the presence of false-positive and -negative results in PSA determinations carried out in clinical practice through the inclusion of 572 men with a negative PSA result and 1081 mean with a positive result from 20 primary health centres in the Valencian Community who have been followed up for 2 years [ 18 ]. The information of this previous study about the probability of having a false positive result will provide patients with information applicable to their setting.…”