Opportunistic prostate‐specific antigen testing in Norwegian men: a public health challenge

Abstract

ObjectiveTo describe age‐specific PSA distributions and resulting prostate cancer diagnoses that arise from population wide opportunistic PSA testing.Patients and MethodsOver 8 million PSA tests were performed on over 1.4 million Norwegian men from 2000‐2020. During this period 43486 men were diagnosed with localized prostate cancer. Most of the PSA testing reflected opportunistic testing. Age specific PSA value distributions were constructed for men aged 45‐75 years with and without prostate cancer.ResultsThe distributions of PSA values in men with and without prostate cancer widened with age and overlapped extensively from 3 to 7 ng/ml. Localized prostate cancer diagnoses increased tenfold from age 45 to age 75 years. PSA testing identified intermediate or high‐grade cancers in 21% (95% CI 19%‐23%) of men aged 50‐54 years and 42% (95% CI 41‐43%) of men aged 70‐74 years. GG1, GG2, GG3 and >GG4 constituted 49%, 31%, 10% and 10% of cancers identified at age 50‐54 years and 26%, 26%, 18%, and 30% of cancers identified at age 70‐74 years.ConclusionOpportunistic PSA testing increases with aging and often generates values that cannot discriminate benign prostate enlargement from prostate cancer. A clinical cascade using additional imaging or serum tests is necessary to avoid negative biopsies and the overdiagnosis of indolent disease. The declining specificity of PSA testing with aging poses a significant public health challenge especially among men older than age 70 years.

Excess weight, weight gain, and prostate cancer risk and prognosis: the PROCA-life study

“…This increase in incidence also parallels the increase in excess weight in the Norwegian population as the prevalence of obesity in adult men has increased substantially during the study period, from 10% in 1994-95% to 21% in 2007-2008 [4]. In addition, the increased incidence parallels in time with a widespread opportunistic use of PSA-tests, and although Norway has never had an organized PSA screening program [36], opportunistic use of PSA testing has been shown to increase with age [37].…”