Evidence of prostate cancer screening in a UK region

Abstract

≥ 50 years had at least one PSA test. Men aged < 50 years accounted for 12.9% of first tests. The proportion of tests from primary care increased from 47.2% in 1993 to 67.0% in 1999. The mean age of men tested once decreased from 65.6 to 61.9 years ( P trend < 0.001) and the proportion with an elevated PSA level also declined during the period. Repeat testing increased with PSA level ( P < 0.001) but 29.4% of men with a PSA level of £ 4 ng/mL also had repeat testing. Raised PSA values were more common from hospital than primary care (32.4% vs 20.6%, P < 0.001) and in older men. Test rates varied 100-fold across general practices, a finding not explained by sociodemographic factors, but one which reflects differential adherence to national guidelines, suggesting that general practitioners are key targets for attempting to rationalise the use of the PSA test. CONCLUSIONThese findings suggest that PSA screening is taking place against evidence-based advice and has resulted in over 20 000 men being designated as having a raised PSA level, creating a need for further assessment. KEYWORDSprostate specific antigen, prostate cancer, screening, PSA OBJECTIVETo examine the pattern of use of prostatespecific antigen (PSA) testing in a UK region, where National Health Service policy does not recommend screening for prostate cancer. SUBJECTS AND METHODSData were collected on all PSA tests in Northern Ireland between 1990 and 1999. Annual rates of PSA testing were calculated by age, GP Practice and year. RESULTSIn all, 165 862 PSA tests were performed on 84 669 men, and over a third of men aged

Baseline Prostate-Specific Antigen Level and Risk of Prostate Cancer and Prostate-Specific Mortality: Diagnosis Is Dependent on the Intensity of Investigation

“…Northern Ireland has a population of f820,000 men of whom 220,000 (26.6%) are over 50 years old (12). The population is stable and homogenous with little migration (0.7% annually) and 99.2% of its inhabitants are White (12).…”

Methods of Calculating Prostate-Specific Antigen Velocity

“…These data are routinely linked to hospital discharge and histopathology data to identify men who have been diagnosed with prostate cancer or histologically confirmed benign disease (biopsy and transurethral resection of the prostate). Although PSA screening for prostate cancer is not recommended in NI, there is recent evidence of increasing opportunistic screening within the region [13]. All patient identifiable information was removed before the research team accessed the data used in this study; no patient contact was made during the study.…”

Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?

“…7,8 Briefly, data on all men undergoing PSA testing in Northern Ireland (NI) are maintained on a central electronic database. Using unique identifiers (name, date of birth and address), PSA results are matched to identify repeat tests for each individual.…”