Prostate-specific Antigen (PSA) Testing Is Prevalent and Increasing in Stockholm County, Sweden, Despite No Recommendations for PSA Screening: Results from a Population-based Study, 2003–2011

Nordström, Tobias; Aly, Markus; Clements, Mark; Weibull, Caroline E.; Adolfsson, Jan; Grönberg, Henrik

doi:10.1016/j.eururo.2012.10.001

Cited by 89 publications

(89 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More information is needed on the availability of the latest PSA screening evidence (1,14) and this could be sent directly to the GPs or made accessible on the widely used websites and the PCRMP website.…”

Section: Discussionmentioning

confidence: 99%

GPs views and understanding of PSA testing, screening and early detection; survey

et al. 2016

View full text Add to dashboard Cite

Background: There is currently no national prostate cancer screening programme in the UK. However, patients 50 years and older are entitled to a prostate specific antigen (PSA) test, if informed on the advantages and disadvantages of testing and their risk of cancer. The Prostate Cancer Risk Management Programme (PCRMP) provides this guidance. Aim: The aim of this study was to access GPs' views and understanding of PSA testing, prostate cancer screening and early detection. Method: A total of 708 questionnaires were returned by GPs across two English regions in 2013 and the GP questionnaire responses were quantitatively analysed. Results: In the 699 completed questionnaires, the majority of GPs were well informed about PSA testing, screening and early detection. Only 32% used guidelines for referral, 14% knew all age-specific PSA referral levels, 71% that Black men have a higher prostate cancer risk than White men (22% correctly answered threefold increase) and 82% that family history is a risk factor. A further 78% thought electronic prompts during consultation would encourage PCRMP guideline usage and 75% had never been offered a PSA test and prostate cancer educational course, of which 73% would like to attend a course. Only 23% were aware of the latest PSA screening evidence (1) and 94% would like an update. Conclusions: Participating GPs seem to be well informed but need more information and tools to help follow recommended guidance. In particular, increased awareness of PCRMP guidelines especially by automated methods, further educational courses and evidence updates would be beneficial. What's known• To our knowledge, there are no similar large published surveys on GPs views and understanding of PSA testing, screening and early detection within England and the PCRMP guidelines.

show abstract

Section: Discussionmentioning

confidence: 99%

GPs views and understanding of PSA testing, screening and early detection; survey

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In addition, several studies indicate that information about optimal retesting schedules in primary care is sparse. 11 For instance, studies among US and Australian men aged 50-75 years showed that 42% had repeated PSA testing within the last 12 months. More importantly, these men did not perceive the increased risk of overdetected PCa as negative aspect which reflects the uncritical perception of screening per se.…”

Section: Discussionmentioning

confidence: 99%

“…The main criticism of PSA-screening is it increasing frequency in several countries worldwide and the arbitrarily chosen retest intervals that seem to be irrespective of men's baseline PSAvalues. 10,11 If the value of baseline PSA was integrated in primary care, many retests might be saved while a considerable number of men could be reassured to be free from potential harmful cancer. According to the low rate of aggressive PCa among men aged 55-74 years with baseline values <1.0 ng ml 21 during two subsequent screening rounds of 4 years each, a retest interval of 6-8 years has been proposed by two studies.…”

mentioning

confidence: 99%

Is further screening of men with baseline PSA < 1 ng ml⁻¹worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau)

et al. 2015

View full text Add to dashboard Cite

Recent studies indicate frequent early PSA retesting unrelated of men's baseline PSA, which increases the harms of early detection especially among men with low PSA. The current study investigates the PCa incidence among men with baseline PSA <1.0 ng ml 21 in order to adjust retest intervals for more targeted early detection. Between 1998 and 2012, 2,416 men with baseline PSA <1.0 ng ml 21 were prospectively observed. Primary endpoint was PCa diagnosis. Negative predictive value (NPV) and number needed to screen (NNS) to detect one PCa were calculated. During a median follow-up time of 12.1 years, 54 (2.2%) PCa were diagnosed with n 5 26 (48.1%) among men with baseline PSA of 0.75 1.0 ng ml 21 (upper baseline PSA quartile). The 10-year probability of being diagnosed with PCa increased significantly from 0.19% (baseline PSA < 0.40 ng ml 21 ) to 2.0% (baseline PSA 0.40 0.56 ng ml 21 ), 2.5% (baseline PSA 0.56 0.75 ng ml 21 ) over 4.4% (baseline PSA 0.75 1.0 ng ml 21 ) (all p values <0.0001), respectively. The frequency of Gleason 7 PCa increased from 1 (0.17%) to 8 (1.4%), 5 (0.8) over 11 (1.8%) in these groups. The 8-year NPV for Gleason 7 PCa were 99.8 (baseline PSA < 0.40 ng ml 21 ), 99.8 (baseline PSA 0.40 0.56 ng ml 21 ), 100 (baseline PSA 0.56 0.75 ng ml 21 ) and 99.5 (baseline PSA 0.75 1.0 ng ml 21 ), respectively. During 12 years, the numbers were 99.8, 98.6, 99.2, and 98.2, respectively. Therefore, due to the very low rate of Gleason 7 PCa, further screening might be omitted in men with baseline PSA < 0.4 ng ml 21 . Between 0.4 and 1.0 ng ml 21 , an 8-year interval can be discussed.

show abstract

“…For example, data appeared from countries such as the UK and Sweden revealing that men were more frequently tested at higher age, men were often not informed about being tested, and 50% of men with low PSA values (<1.0 ng/ml) were in fact retested within 3 years. 7,8 While, due to the uncertainty about the effect of PSA-based screening on disease specific mortality, mass screening was discouraged, opportunistic testing was going on, and in fact perhaps causing even more harm. The Swedish arm of the ERSPC trial compared the outcome of organized screening (as was done in the intervention arm of ERSPC) with opportunistic screening (as occurred in the Swedish control arm of ERSPC), and concluded that opportunistic screening resulted in over diagnosis and subsequent over treatment, while there was no effect on the rate of metastatic disease or disease specific mortality.…”

Section: After the Outcome Of The Trialsmentioning

confidence: 99%

Pearls for Prostate Cancer Screening

Roobol¹

2017

Oncology &Amp; Hematology Review (US)

View full text Add to dashboard Cite

P rostate cancer screening and its effect on disease-specific mortality has been a topic of debate since the early 1990s. In 2009, after publication of the results of two large randomized prostate cancer screening trials showing contradictory results, the debate continued. Meanwhile, based on the huge amount of data from these two trials it became clear there is no one-size-fits-all for prostate cancer screening. Now, with two recent publications, the debate on whether prostate cancer screening affects mortality can finally be ended. The focus is on how to identify those men that can benefit from screening. KeywordsProstate cancer, screening, PSA, mortality, over diagnosis, biopsy, harm/benefit Disclosure: Monique J Roobol has nothing to declare in relation to this article. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received for the publication of this article.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. 1 With using the PSA test, applying a cut-off ≥4.0 ng/ml, 33% more prostate cancers were detected with the majority being organ confined, and hence candidates for treatment with curative intent.1 While this was seen as a positive result, the possibility of over-diagnosis was mentioned.To assess the effect of PSA-based screening on disease specific mortality, a randomized controlled trial (RCT) is the way to go. Both in Europe and the US, RCTs were initiated in 1993. In the US within the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial, 2 and in Europe within the eight-country consortium, the European Randomized study of Screening for Prostate Cancer (ERSPC). 3 Outcome of the randomized controlled trialsTrial initiation was followed by a long period of recruitment, randomization, screening, and gathering data on incidence and mortality, in both arms. I was responsible for the Dutch part of ERSPC, randomizing more than 42,000 in the region of Rotterdam. In total the ERSPC included more than 182,000 men.3 In the US, approximately 76,000 men participated in the so-called P-arm of the PLCO trial. 2In 2009, both trials published their results on the main outcome, which was prostate cancer-specific mortality. The data had been long awaited. While evidence on the effect on mortality was lacking, use of the PSA test for screening purposes had become more or less standard practice (especially in the US). Both trails showed contradictory results which unfortunately caused even more uncertainty.The ERSPC trial showed that with repeat PSA-based screening in men aged 55-69 years, at t...

show abstract

Prostate-specific Antigen (PSA) Testing Is Prevalent and Increasing in Stockholm County, Sweden, Despite No Recommendations for PSA Screening: Results from a Population-based Study, 2003–2011

Cited by 89 publications

References 28 publications

GPs views and understanding of PSA testing, screening and early detection; survey

GPs views and understanding of PSA testing, screening and early detection; survey

Is further screening of men with baseline PSA < 1 ng ml⁻¹worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau)

Pearls for Prostate Cancer Screening

Contact Info

Product

Resources

About

Prostate-specific Antigen (PSA) Testing Is Prevalent and Increasing in Stockholm County, Sweden, Despite No Recommendations for PSA Screening: Results from a Population-based Study, 2003–2011

Cited by 89 publications

References 28 publications

GPs views and understanding of PSA testing, screening and early detection; survey

GPs views and understanding of PSA testing, screening and early detection; survey

Is further screening of men with baseline PSA < 1 ng ml−1worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau)

Pearls for Prostate Cancer Screening

Contact Info

Product

Resources

About

Is further screening of men with baseline PSA < 1 ng ml⁻¹worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau)