Prostate-specific Antigen Testing Rates Research Articles

Obesity and Prostate Cancer Detection: Insights from Three National Surveys

Background Previous studies suggest that obesity is associated with higher prostate cancer progression and mortality despite an association with lower prostate cancer incidence. This study aims to better understand these apparently inconsistent relationships among obese men by combining evidence from 3 nationally representative cross-sectional surveys. Methods We evaluated relationships between obesity and 1) testosterone concentrations in the Third National Health and Nutrition Examination Survey (NHANES III; n = 845); 2) prostate-specific antigen (PSA) in NHANES 2001-2004 (n = 2458); and 3) prostate biopsy rates in the National Health Interview Survey (NHIS 2000; n = 4789) population. Mean testosterone, PSA concentrations, and biopsy rates were computed for Body Mass Index (BMI) categories. Results Testosterone concentrations were inversely associated with obesity ( P-trend <.0001) in NHANES III. In NHANES 2001-2004, obese (BMI >35) versus lean (BMI <25) men were less likely to have PSA concentrations that reached the biopsy threshold of >4 ng/mL (3% vs 8%; P <.0001). Among NHIS participants, all BMI groups had similar rates of PSA testing ( P = .24). However, among men who had PSA tests, 11% of men with BMI >30 versus 16% with BMI <25, achieved a PSA threshold of 4 ng/mL; P = .01. Furthermore, biopsy rates were lower among men with BMI >30 versus BMI <25 in NHIS participants (4.6% vs 5.8%; P = .05). Conclusions Obesity was associated with lower PSA-driven biopsy rates. These data support further studies to test the hypothesis that obesity affects prostate cancer detection independent of prostate cancer risk by decreasing the PSA-driven biopsy rates.

Annual screening for prostate cancer did not reduce mortality from prostate cancer

### Design: randomised controlled trial (Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). ClinicalTrials.gov NC2540. ### Allocation: {concealed}*.† ### Blinding: blinded (outcome adjudication committee).† ### Setting: 10 centres in...

Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines

Prostate specific antigen (PSA) testing is associated with increased prostate cancer (PCa) incidence. Ireland has no national guidelines on PCa screening and had the highest PCa incidence in Europe, 2006. To investigate trends in PSA testing in Ireland. Data on PSA tests, 1994-2005, was collated. Age-standardised rates of PSA testing increased 39 and 25% annually in men <50 and >or=50 years, respectively. Most tests were performed in men 50-69 years; 26 and 22% were performed in men <50 and >or=70 years, respectively. Baseline PSA tests peaked in 2004, at 16% of men. 83% of baseline tests were <4.0 ng/ml. Repeat testing increased with age and PSA level (P < 0.001); men <50 years and with levels <4.0 ng/ml had >1 tests in <21 months. PCa incidence increased 9% annually, 1994-2005. Uptake of PSA testing was rapid: increased use was simultaneous with increased PCa incidence. National guidelines are needed to manage this important public health issue.

Cancer screening among migrants in an Australian cohort; cross-sectional analyses from the 45 and Up Study

BackgroundLimited evidence suggests that people from non-English speaking backgrounds in Australia have lower than average rates of participation in cancer screening programs. The objective of this study was to examine the distribution of bowel, breast and prostate cancer test use by place of birth and years since migration in a large population-based cohort study in Australia.MethodsIn 2006, screening status, country of birth and other demographic and health related factors were ascertained by self-completed questionnaire among 31,401 (16,126 women and 15,275 men) participants aged 50 or over from the 45 and Up Study in New South Wales.Results35% of women and 39% of men reported having a bowel cancer test and 57% of men reported having a prostate specific antigen (PSA) test, in the previous 5 years. 72% of women reported having screening mammography in the previous 2 years. Compared to Australian-born women, women from East Asia, Southeast Asia, Continental Western Europe, and North Africa/Middle East had significantly lower rates of bowel testing, with odds ratios (OR; 95%CI) ranging from 0.5 (0.4–0.7) to 0.7 (0.6–0.9); migrants from East Asia (0.5, 0.3–0.7) and North Africa/Middle East (0.5, 0.3–0.9) had significantly lower rates of mammography. Compared to Australian-born men, bowel cancer testing was significantly lower among men from all regions of Asia (OR, 95%CI ranging from 0.4, 0.3–0.6 to 0.6, 0.5–0.9) and Continental Europe (OR, 95%CI ranging from 0.4, 0.3–0.7 to 0.7, 0.6–0.9). Only men from East Asia had significantly lower PSA testing rates than Australian-born men (0.4, 0.3–0.6). As the number of years lived in Australia increased, cancer test use among migrants approached Australian-born rates.ConclusionCertain migrant groups within the population may require targeted intervention to improve their uptake of cancer screening, particularly screening for bowel cancer.

Trends in Prostate-Specific Antigen Testing From 1995 Through 2004

The utility of the prostate-specific antigen (PSA) test to screen for prostate cancer has been widely debated for several years. Whether PSA testing rates have changed during this period of controversy is not well known. We examined the National Ambulatory Medical Care Survey (1995-2004) of visits to primary care providers by healthy men aged 35 years or older. We examined visits by calendar year and compared the years 2000 through 2004 with the years 1995 through 1999. We also examined visits by men in the overall population and in particular subgroups. Primary care physicians ordered PSA tests in 4.7% of all visits in 1995 and in 7.0% of all visits in 2004 (P = .03). In multivariate analysis, the odds of a primary care physician ordering a PSA test during any clinic visit increased 8% (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12; P < .001) per year from 1995 through 2004. The increase was more pronounced among men making visits for general medical examinations (11.2% in 1995 vs 32.3% in 2004; P = .003). Comparing the period 2000-2004 with the period 1995-1999, the odds of PSA testing increased in nearly all subgroups but most dramatically in black men (OR, 2.3; 95% CI, 1.4-3.8; P = .002) and in men 35 through 49 years of age (OR, 1.8; 95% CI, 1.3-2.6; P = .001). In a nationally representative sample, we found that despite the lack of clear evidence of benefit, PSA testing for prostate cancer screening has increased dramatically, especially among black men and younger men.

Receiver operating characteristics of the prostate specific antigen test in an unselected population

To determine the operating characteristics of prostate-specific antigen (PSA) testing and prostate cancer diagnosis rates in men who have had an initial PSA test in Tayside. A retrospective cohort study in Tayside, Scotland from 1992 to 2001. In total, 20,623 men were PSA tested during the period 1992-2001. After exclusions, 19,660 were studied. Sensitivity and specificity were calculated for various PSA cut-off values by age group using logistic regression weighted for verification bias (biopsy). Cox regression analysis was performed using six test pattern cohorts. The annual rate of PSA testing increased from 5.1 per 1000 man years in 1992 to 21.3 per 1000 man years in 2001. The average number of PSA tests per patient increased from 1.11 in 1992 to 2.57 in 2001. Prostate cancer diagnosis and death rates remained constant from 1995 onward. The PSA test had generally inadequate sensitivity and specificity values, so a unique cut-off could not be found for the two older age groups which could be used as a recommendation for biopsy. The commonly used 4 ng/mL cut-off was reasonably sensitive and specific only for the under 60 age group with values of 92.4% and 90.7%, respectively. For prostate cancer diagnosis, the hazard ratios (HR) were reported relative to those with a series of all normal tests. For those with an initially normal PSA test who had at least one abnormal retest result the HR for diagnosis was 10.43 (95% confidence interval [CI] 6.17-17.63). For those with initially abnormal tests with normal retests HR = 1.63 (95% CI 0.65-4.07). There are no optimal PSA cut-off values for older age groups with which to make a confident referral for biopsy. The increase in PSA testing and the questionable cut-off values of the test calls for the development of an alternative screening strategy.

A population‐based survey of prostate‐specific antigen testing among California men at higher risk for prostate carcinoma

Despite the lack of evidence demonstrating a survival benefit from prostate-specific antigen (PSA) screening, its use has become widespread, organizations have encouraged physicians to discuss early detection of prostate carcinoma, and two higher risk groups have been recognized. In the current study, the authors examined whether African-American men and men who had a family history of prostate carcinoma underwent PSA testing preferentially, and patterns of test use were examined according to age, race, and other factors. Data regarding self-reported PSA test use in the past year among men age 50 years and older without a history of prostate carcinoma (n = 8713 men) were analyzed from the 2001 California Health Interview Survey. The overall rate of PSA use was 43.0%. Older age, higher socioeconomic status, having a usual source of healthcare, and a family history of prostate carcinoma were the strongest predictors of testing. Higher risk African-American men age 50 years and older were no more likely to be tested than white men. Men at higher risk who had a family history of prostate carcinoma were more likely to have been tested than men who had no such family history. Rates of PSA use among higher risk men who had a family history of prostate carcinoma were higher compared with the rates among men without such a family history. However, PSA testing rates among higher risk African-American men were no different than the rates among lower risk white men, suggesting that some risk factors for prostate carcinoma (but not others) are associated with preferential testing. Testing in all groups was associated with access to care variables, highlighting the importance of removing barriers to preventive healthcare services.

Evidence of prostate cancer screening in a UK region.

To examine the pattern of use of prostate-specific antigen (PSA) testing in a UK region, where National Health Service policy does not recommend screening for prostate cancer. Data were collected on all PSA tests in Northern Ireland between 1990 and 1999. Annual rates of PSA testing were calculated by age, GP Practice and year. In all, 165 862 PSA tests were performed on 84 669 men, and over a third of men aged > or = 50 years had at least one PSA test. Men aged < 50 years accounted for 12.9% of first tests. The proportion of tests from primary care increased from 47.2% in 1993 to 67.0% in 1999. The mean age of men tested once decreased from 65.6 to 61.9 years (P trend < 0.001) and the proportion with an elevated PSA level also declined during the period. Repeat testing increased with PSA level (P < 0.001) but 29.4% of men with a PSA level of < or = 4 ng/mL also had repeat testing. Raised PSA values were more common from hospital than primary care (32.4% vs 20.6%, P < 0.001) and in older men. Test rates varied 100-fold across general practices, a finding not explained by sociodemographic factors, but one which reflects differential adherence to national guidelines, suggesting that general practitioners are key targets for attempting to rationalise the use of the PSA test. These findings suggest that PSA screening is taking place against evidence-based advice and has resulted in over 20 000 men being designated as having a raised PSA level, creating a need for further assessment.

PREVALENCE AND CORRELATES OF PROSTATITIS IN THE HEALTH PROFESSIONALS FOLLOW-UP STUDY COHORT

Prostatitis is an ill-defined condition whose symptoms overlap with benign prostatic hyperplasia (BPH). Little is known about the prevalence and correlates of prostatitis, or factors that distinguish prostatitis from BPH. We examined these issues in a large, nationwide sample of healthy men. In 1992, 31,681 United States health professionals without prostate cancer provided information on urological diagnoses, lower urinary tract symptoms, and demographic, clinical and lifestyle factors. We calculated age adjusted odds ratios and 95% confidence intervals for these correlates predicting a history of prostatitis. We also compared characteristics of men with prostatitis to those with BPH. The prevalence of a self-reported history of prostatitis was 16%. Men reporting a history of BPH had 7.7-fold greater odds of a history of prostatitis, those with moderate or severe lower urinary tract symptoms had 1.8 and 2.8-fold greater odds, respectively, those with a history of sexually transmitted disease had 1.8-fold greater odds and those reporting stress at home or work had 1.5- and 1.2-fold greater odds, respectively. The 2,163 men with prostatitis alone were younger and had less severe urinary tract symptoms (but a similar pattern of symptoms) than the 4,575 men with BPH alone. Self-reported prostatitis was common among healthy men of all ages but there was considerable overlap with self-reported BPH. Prostatitis had several identifiable correlates that may aid in its recognition.

Rise and fall of radical prostatectomy rates from 1989 to 1996

Objectives. To describe the changes in the rates of radical prostatectomy procedures, prostate-specific antigen (PSA) screening tests among Medicare beneficiaries, and the incidence of prostate cancer in the United States and to explain the exaggerated increase and decrease in the frequency of radical prostatectomy from 1989 to 1996.Methods. Medicare claims data on radical prostatectomy procedures and screening PSA tests and the National Cancer Institute’s Surveillance, Epidemiology, and End Results prostate cancer incidence data were used to estimate the rates of PSA testing and radical prostatectomy among Medicare beneficiaries aged 65 to 74 years and 75 years and older (population rates). The age-specific true rates of the procedure were also estimated for the incident cases of prostate cancer (the population at risk of undergoing radical prostatectomy) among the beneficiaries.Results. The PSA test, prostate cancer incidence, and radical prostatectomy rates increased from 1989 to 1992. Thereafter, the incidence of prostate cancer, and the population and true rates of radical prostatectomy declined. The percentage of increase and decrease in the population rate of radical prostatectomy was approximately twice that in its true rate.Conclusions. The radical prostatectomy rates based on all Medicare beneficiaries grossly exaggerated the changes in the use of the procedure. Where possible, true rates, using the population at risk as the denominator, should be used in the studies of diagnostic and therapeutic procedures, complications, and adverse effects.

Survey of the rate of PSA testing in general practice.

The use of prostate specific antigen (PSA) test could have a large impact on the incidence of prostate cancer in the UK. Over a period of 1 year (1999), 3.5% out of 160 015 men aged > 45 on a GP database, who had no previous record of prostate cancer, had a PSA test. Of the tested men, 21.3% had a PSA > 4 ng/ml. Future data need to distinguish between men with and without symptoms. © 2001 Cancer Research Campaign http://www.bjcancer.com

Rising incidence of prostate cancer in Scotland: increased risk or increased detection?

To assess the extent to which the increasing incidence of prostate cancer in Scotland can be explained by increased detection, particularly through transurethral resection of the prostate (TURP) and use of the prostate-specific antigen (PSA) test. Subjects and methods This population-based study was confined to men resident in Scotland and aged > or =50 years. Temporal trends were examined in age-specific and age-standardized incidence, mortality and TURP rates, and PSA testing rates during 1981-1996. Also analysed were the geographical variations in age-standardized incidence and mortality rates during two distinct periods, 1984-1986 (before PSA testing) and 1994-1996 (after PSA testing). Finally, incidence rates and relative survival at 5 years were calculated by age group and 5-year periods of diagnosis during 1968-1992. The incidence of prostate cancer in men aged > or = 50 years increased from an age-standardized rate of 142.0 per 100 000 in 1981 to 240.9 in 1996, with the steepest increase occurring between 1992 and 1993. The mortality rate increased similarly until 1993, but was relatively stable thereafter, falling slightly in 1996. In 1981-1988, incidence rates were closely correlated with TURP rates (r = 0.98, P<0.001). In 1989-1996, incidence was closely correlated with PSA testing rates (r = 0.98, P<0.001). By 1994-1996, incidence rates varied substantially between Scottish mainland health boards (range 167.7-303.0 per 100 000), with much less variation in mortality rates (90.7-110.0). Relative survival has increased recently in all age groups although, in the era before PSA testing, survival was reasonably stable despite increasing incidence. Although there may have been a true increase in risk, much of the observed increase in the incidence of prostate cancer in Scotland between 1981 and 1996 has been caused by increased detection, leading recently to considerable variation among different areas of the country. The extent to which this represents the early diagnosis of tumours which would eventually cause symptoms or be life-threatening, or detection of latent disease which would never have become symptomatic, is not clear. There is no evidence so far that the increased incidence is associated with any substantial reduction in mortality.

High Rates of Prostate-specific Antigen Testing in Men with Evidence of Benign Prostatic Hyperplasia

Purpose: Benign prostatic hyperplasia is common among men who may be candidates for prostate cancer screening using prostate-specific antigen (PSA) testing. Patterns of PSA testing among men with evidence of benign prostatic hyperplasia have not been studied. Methods: We examined the prevalence and correlates of a self-reported history of PSA testing. In 1994, 33,028 US health professionals without prostate cancer aged 47 to 85 years provided information on prior PSA testing, lower urinary tract symptoms characteristic of benign prostatic hyperplasia, history of prostatectomy, and prostate cancer risk factors. In 1995, a subset of 7,070 men provided additional information on diagnosis and treatment of benign prostatic hyperplasia. Results: From 39% of men in their 50s to 53% of men in their 80s reported PSA testing in the prior year ( P <0.0001 for trend with age). Men were more likely to report PSA testing if they had lower urinary tract symptoms characteristic of benign prostatic hyperplasia (age-adjusted odds ratio for severe symptoms 2.2, 95% confidence interval 1.8 to 2.6), a prior history of prostatectomy (age-adjusted odds ratio 1.1, 95% confidence interval 1.02 to 1.2), or a physician diagnosis of benign prostatic hyperplasia (odds ratio 1.9, 95% confidence interval 1.7 to 2.2; adjusted for age, signs or symptoms of benign prostatic hyperplasia, and prostate cancer risk factors). Conclusions: These US health professionals reported preferential use of PSA testing among men least likely to benefit from early cancer detection (older men) and among men most likely to have a false-positive PSA result (men with benign prostatic hyperplasia). Physician and patient education are needed to promote more rational and selective use of this screening test.