Is there any association between prostate-specific antigen screening frequency and uptake of active surveillance in men with low or very low risk prostate cancer?

Kerri Beckmann,Martin Eklund,Anna Wallerstedt Lantz,Markus Aly,Mieke Van Hemelrijck,Jan Adolfsson,Netty Kinsella,Henrik Olsson,Tobias Nordstrom

doi:10.1186/s12894-019-0502-4

Abstract

BackgroundPatient-related factors such as concern about cancer are believed to influence both men’s decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa). The potential link between screening frequency and choice of active surveillance (AS) for low risk disease has not been studied previously. Our aim was to investigate whether there is any association between PCa screening frequency or previous negative prostate biopsy and uptake of AS among men with low risk PCa.MethodsThis register-based study included all men ≤75 years from Stockholm who were diagnosed with low risk PCa from 2008 to 2014 (n = 4336). Pre-diagnostic PSA testing and biopsy histories were obtained from the Stockholm PSA and Biopsy Register, a population-based register for the Stockholm country. The association between previous screening/biopsy history and AS uptake (based on primary treatment recorded in the National Prostate Cancer Register) was examined using multivariable logistic regression.ResultsForty seven percent of men with low risk PCa underwent AS. Uptake was associated with older age, very low risk disease, more recent diagnosis and absence of family history. None of the screening/biopsy measures (testing frequency, mean interval, PSA velocity, highest pre-diagnostic PSA or prior negative biopsy) were associated with uptake of AS among men with low risk PCa. Generalisability to settings with different policies and practices may be limited.ConclusionWe found no evidence that screening frequency and negative biopsy influence uptake of AS among Swedish men with low risk PCa. Further research is required to determine factors that still present barriers for men taking up AS.

Highlights

Patient-related factors such as concern about cancer are believed to influence both men’s decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa)
PSA testing and prostate biopsy history are shown in Table 2 according to active surveillance (AS) status
Our study is the first to explore whether frequency of PSA testing, PSA results or the experience of a negative prostate biopsy influence uptake of AS among men diagnosed with low risk PCa

Summary

Introduction

Patient-related factors such as concern about cancer are believed to influence both men’s decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa). The potential link between screening frequency and choice of active surveillance (AS) for low risk disease has not been studied previously. Similar factors have been reported to drive PSA screening, where men identify concerns about cancer, the need for peace of mind and control over one’s health as reasons for undergoing PSA testing [14, 15]. Several interview and internet content-based studies have suggested the psychological burden associated with ongoing monitoring during active surveillance, as well as the morbidity associated with repeat biopsy, may be linked to reduced uptake AS [19]. Other studies have emphasized the process of repeated monitoring while on active surveillance as reassuring [20]

Objectives

Methods

Results

Discussion

Conclusion