OLDER, asymptomatic men are getting tested for prostate cancer more often than guidelines recommend, sometimes leading to further invasive tests and treatments, some of which are unnecessary or cause harm, according to research published today by the Medical Journal of Australia.
Measuring prostate-specific antigen (PSA) levels is widely used for screening for early diagnosis of prostate cancer, however, the value of PSA testing for reducing prostate cancer-specific or all-cause mortality among asymptomatic men is uncertain.
Current guidelines recommend that men aged 50–69 years be offered biennial PSA testing if they make an informed decision to be tested.
Researchers from Macquarie University and Outcome Health analysed routinely collected data from 180 Victorian general practices for all men who had attended the same practice at least three times during October 2016 to September 2018. They aimed to investigate the age-specific patterns of prostate-specific antigen (PSA) testing and PSA levels in men aged 40 years or more without symptoms of prostate cancer.
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“A total of 142 016 male patients were identified,” reported the researchers, led by Guilherme Franco, from the Australian Institute of Health Innovation at Macquarie University.
“The proportion who underwent PSA testing at least once (prevalence) or at least twice during the study period increased with age: prevalence peaked with the 65–69 year age group (8132 men tested, 54% of age group), and the proportion of men tested at least twice with the 70–74 year age group (3159 men, 46% of age group).
“A total of 78 818 PSA test results were recorded during the study period; about one-third were for men aged 60–69 years (25 496 tests, 32%).
“The median PSA level increased from 0.7 ng/mL for men aged 40–44 years to 1.9 ng/mL for men aged 85 years or more. The median PSA level increased by 3.2% per year of age.”
Franco and colleagues wrote that the high PSA testing prevalence among older men was similar to previous Australian reports (48% of men aged 70 years or more reported they had a PSA test in the preceding 2 years), and the PSA levels matched current age-specific 95th percentile reference ranges.
“Why patterns of testing are different than recommended (ie, more frequently than biennial and beyond 69 years of age) cannot be explained by general practice data, but reasons may include patient expectations, fragmentation of care, and the persistence of old guideline recommendations,” they concluded.
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