Prostate-specific antigen testing rates and referral patterns from general practice data in England

Moss, Sue; Melia, Jane; Sutton, Jaim; Mathews, Christopher; Kirby, Michael

doi:10.1111/ijcp.12784

Cited by 20 publications

(22 citation statements)

References 15 publications

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“…However prior to this, in 2007, a small survey was undertaken on GP knowledge of PSA testing in asymptomatic men and the similarities to the PCRMP guidance, with 21 GPs from 18 GP practices in Oxfordshire; which showed that more GP education was needed on PSA testing (15). In addition the Clinical Practice Research Datalink (CPRD) PSA testing rates and referral patterns study that was carried out with this study, showed that PSA testing rates increased from 2010 to 2011, GPs often retest patients with raised PSA levels before referral and overall referral is low, which further supports the findings of this study and the need for increased guideline awareness and GP education (16).…”

Section: Comparison With Existing Literaturesupporting

confidence: 77%

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

et al. 2016

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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.

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Section: Comparison With Existing Literaturesupporting

confidence: 77%

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

et al. 2016

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“…The proportion of patients who underwent a PSA screening in our study performed in France is much higher than those reported by other authors [23][24][25][26][27][28][29][30]. For men aged 50-74 years, the observed 41.05% rate of French patients who had undergone a PSA screening is comparable to the participation in systematic screenings for colorectal cancer or breast cancer.…”

Section: Discussioncontrasting

confidence: 66%

Factors Related to Prostate-Specific Antigen–Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years (Preprint)

Rat¹,

Schmeltz²,

Rocher³

et al. 2018

Preprint

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BackgroundInternational guidelines recommend that PSA-based prostate cancer screening be avoided in elderly patients with a life expectancy shorter than ten years. However, for men aged 50 to 69, most recommendations encourage an individual approach that considers the patient's comorbidities after a shared decision-making process. ObjectiveThe first objective of this study was to assess the inappropriate application of PSA-based prostate cancer screening in men older than 74. The secondary objective was to assess whether the presence (vs absence) of comorbidities was related to PSA testing in younger men eligible for screening (ages 50 to 74). MethodsWe analyzed data from the French national healthcare database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014 to March 31, 2016; the first included men older than 74 years, and the second included men aged 50 to 74 years.We first analyzed whether these patients received PSA testing after two years of follow-up.We then analyzed whether PSA testing was related to variables such as age, low income, and frailty. Frail individuals were identified by proxy measures illustrative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, having five or more drugs per day) or by proxy measures illustrative of the following specific comorbidities:cancers, cardiovascular diseases, visceral failures, or psychiatric disorders. Statistical analysis was based on a multivariate mixed effects logistic regression. ResultsThe proportion of patients who received a PSA-based screening test was 41.4% (9296 / 22480) among men older than 74 and 41.1% (40275 / 98107) among men aged 50 to 74 (p = 0.41). The following factors were associated with less frequent PSA testing in men older than 74: older age, suffering from a chronic disease, repeated ambulance transportation, diabetes, dementia, psychiatric disorders, and a low income, whereas being treated with cardiovascular drugs was associated with more frequent PSA testing. The following factors were associated with less frequent PSA testing in men aged 50 to 74: suffering from a chronic disease, repeated ambulance transportation, having more than 4 drugs per day, diabetes, psychiatric disorders, being treated by antiaggregant, and having a low income, whereas older age and being treated with other cardiovascular drugs was associated with more frequent PSA testing. ConclusionsIn this study, 41.1% of French men older than 74 had a PSA-based screening test. PSA testing depends on patients' comorbidities. However, PSA testing remains inappropriate in certain populations with major comorbidities (e.g., dementia or visceral failure). Lower screening rates in patients using insulin or with a low income might have no relation to life expectancy.

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“…A more recent study analysed data from patient electronic records in primary care for men aged 45–84 years. It reported that for every 100 men enrolled with a general practitioner (GP) for one year, 5.03 (asymptomatic men) were tested in 2010, and the rate increased by 8% in 2011 to 5.45 per 100 5. Note that the data this analysis was based on represent only 5% of the population in England and may not be representative of all practices.…”

Section: Introductionmentioning

confidence: 99%

Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study

et al. 2016

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ObjectivesTo examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.DesignA grounded theory study.SettingPrimary care practices in Australia and the UK.Participants69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.ResultsGPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.ConclusionsThe GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.

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Prostate-specific antigen testing rates and referral patterns from general practice data in England

Cited by 20 publications

References 15 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

Factors Related to Prostate-Specific Antigen–Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years (Preprint)

Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study

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