PSA testing in general practice

Abstract

INTRODUCTION: In New Zealand, prostate-specific antigen (PSA) testing has increased significantly (275 000 tests/year). Controversy exists around PSA testing as part of an unorganised screening programme. AIM: To look at the use of PSA testing in a sample of general practices and investigate the reasons GPs undertake PSA testing. METHODS: Five Waikato general practices investigated looking at PSA laboratory tests of men =40 years in 2010 compared against GP notes. Testing rates, reasons for testing, histology and referral/s were examined for different age groups. A questionnaire was sent to the GPs to determine their views on PSA testing. RESULTS: One in four men aged 40+ years had a PSA test in 2010. Of these men, 71% were asymptomatic. More than half of men tested aged 70+ years were asymptomatic. Ten percent of all PSA tests were elevated. Twenty-one of 23 prostate cancers were diagnosed following an elevated PSA test: more than 80% of these men had histories of prostate pathology or lower urinary tract symptoms. The questionnaire confirmed that GPs believe in the benefits of PSA screening and it also showed they had difficulty in providing patients with information about pros and cons of PSA testing. DISCUSSION: All GPs in this study tested asymptomatic men. GPs in this study value PSA screening and believe that it reduces mortality rates. However, although PSA tests were most frequently done on asymptomatic patients, the majority of patients subsequently diagnosed with prostate cancer had been tested because of symptoms or had previous prostate problems. KEYWORDS: Prostate specific antigen (PSA); PSA testing; screening; prostate cancer; general practitioners

Rural‐Urban Differences in Prostate‐Specific Antigen (PSA) Screening and Its Outcomes in New Zealand

“…New Zealand has one of the highest incidence rates of prostate cancer worldwide, probably due to high rates of PSA testing . The level of PSA is currently considered to be the best single test for early prostate cancer detection, despite its limitations . The PSA test is used either for screening of asymptomatic men, or as an aid for prostate cancer detection in symptomatic men and for monitoring the progress of prostate cancer after diagnosis …”

“…1,13 The level of PSA is currently considered to be the best single test for early prostate cancer detection, despite its limitations. 14,15 The PSA test is used either for screening of asymptomatic men, or as an aid for prostate cancer detection in symptomatic men and for monitoring the progress of prostate cancer after diagnosis. 15,16 There is persisting uncertainty about the benefits and harms of population-based screening for prostate cancer.…”

Peer Review #2 of "An examination of clinical differences between carriers and non-carriers of chromosome 8q24 risk alleles in a New Zealand Caucasian population with prostate cancer (v0.1)"

“…men who would die with prostate cancer and not from prostate cancer. NZ does not recommend PSA screening for asymptomatic men but the National Health Committee agree that prostate cancer is a suitable candidate for screening (NHC, 2004) and for example, one in four men over the age of 40 years living in the Waikato District of NZ were tested for PSA in 2010 (Hodgson et al, 2012). Of these, 71% were asymptomatic (Hodgson et al, 2012).…”

SNP-SNP interactions as risk factors for aggressive prostate cancer

“…These samples were taken from a New Zealand cohort of men with self-reported European ethnicity that have been clinically diagnosed with aggressive and non-aggressive PCa, and healthy controls with no reported symptoms of the disease. Symptoms include increased urination during night time along with a frequent urge to urinate problems maintaining a steady flow of urine, hematuria and dysuria 15 . Our results indicate a strong influence of gene x environment interaction in overall gene expression and epistasis.…”