Prostate specific antigen testing is associated with men’s psychological and physical health and their healthcare utilisation in a nationally representative sample: a cross-sectional study

Abstract

BackgroundProstate cancer incidence has risen considerably in recent years, primarily due to Prostate Specific Antigen (PSA) testing in primary care. The objective of this study was to investigate associations between PSA testing and the psychological and physical health, and healthcare utilisation of men in a population where PSA testing is widespread.MethodsA cross-sectional study was carried out in a population-representative sample of men ≥50 years enrolled in The Irish Longitudinal Study on Ageing (TILDA). TILDA participants underwent structured interviews, health assessments and completed standardised questionnaires. Men were classified as ever/never having received a PSA test. Multivariate logistic regression (Odds Ratios (OR) and 95% Confidence Intervals (CI) was used to determine associations between PSA testing, and men’s psychological and physical health and healthcare utilisation.ResultsThis analysis included 3,628 men, 68.2% of whom ever had a PSA test. In adjusted analysis, men with sub-threshold depression were significantly less likely to have had a PSA test, (OR = 0.79, 95% CI 0.64-0.97). Likelihood of having a PSA test was inversely associated with anxiety, but this was not significant (OR = 0.79, 95% CI 0.57-1.09). Frailty (OR = 0.61, 95% CI 0.31-1.05) and eligibility for free primary care (OR = 0.63, 95% CI 0.52-0.77) were also inversely associated with PSA testing. Positive associations were observed between PSA testing and more chronic illnesses (OR = 1.11, 95% CI 1.05-1.19), more primary care visits (OR = 1.03, 95% CI 1.01-1.05) and preventative health practices, including cholesterol testing and influenza vaccination (OR = 1.35, 95% CI 1.13-1.60).ConclusionsMen’s psychological and physical health and their healthcare utilisation are associated with PSA testing in primary care. The association between poorer psychological health, in particular sub-threshold depression, and reduced likelihood of PSA testing in primary care requires further investigation. These findings may have wider implications for other cancer screening.

Pre-diagnostic statin use, lymph node status and mortality in women with stages I–III breast cancer

“…However, we expect that women are unlikely to continue filling prescriptions for medication they no longer take. It is important to consider that statins may be preferentially prescribed for, and taken by, patients who engage in healthier behaviours and have superior health outcomes ( Evans et al , 1995 ; Brookhart et al , 2007 ; Flahavan et al , 2014 ). This is known as healthy-user bias and may cause an overestimation of any beneficial effect of statins ( Glynn et al , 2006 ).…”

Mode of prostate cancer detection is associated with the psychological wellbeing of survivors: results from the PiCTure study

“…This they hypothesise may be due to (i) adherent patients being ‘more health seeking’ and therefore more likely to seek or agree to take other preventative interventions and tests and/or (ii) differences in health status (physical and cognitive) between the two groups, with those who are adherent being healthier. Additionally, men with poorer psychological health have been found to be less likely to have PSA tests [ 32 – 34 ]. Moreover, those predisposed to poorer psychological health are also predisposed to poor wellbeing throughout their disease trajectory [ 35 ].…”

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

“…We also evaluated potential variables associated with a PSA request that was potentially non-compliant with the current guideline. We speculated that some specific patient characteristics (diabetes diagnosis [ 8 , 9 ], consuming tobacco, alcohol, or other drugs [ 10 , 11 ]) could be associated with lower probability of having a potentially non-compliant PSA test due to lower testing frequency. Nevertheless, although we found no difference in PSA test compliance with the guideline in patients with diabetes diagnoses, those who were current consumers of tobacco, alcohol, and/or other drugs showed 20% lower potential non-compliance.…”

“…PSA non-compliance in these patients was partially explained by shorter life expectancy, but patients diagnosed with another neoplasm had an 18% higher frequency of potentially non-compliant PSA petitions after adjusting for age and life expectancy. Available evidence has reported that patients with a previous cancer diagnosis were more likely to have a PSA test [ 10 ], which could be due to increased contact with healthcare services.…”

“…The intervals between testing were often shorter than recommended, and screening among younger men without risk factors was frequent [ 7 ]. In addition, a different PSA testing behaviour has been described among patients with certain characteristics, such as men with diabetes [ 8 , 9 ], patients with cancer [ 10 ], or non-smokers [ 10 , 11 ].…”