OBJECTIVE: To analyse the trends of opportunistic PSA screening in Australia focussing on younger men (< 55 years of age) to examine its effects on TRUS-BX rates and determine the nature of prostate cancers (PCs) being detected.
MATERIAL AND METHODS: All men who received an opportunistic screening PSA tests and Trans-rectal ultrasound- guided biopsies (TRUS-BX) from 2001-08 in Australia were analysed using the Australian Cancer registry (Australian Institute of Health and Welfare) and Medicare databases. Victorian cancer registry was used to obtain Gleason scores. Both age-standardised and -specific rates were calculated along with incidence of PC and correlated with Gleason scores.
RESULTS: A total 5,174,031 PSA tests detected 128,167 PCs from 2001-08. During this period, PSA testing increased by 146% (a mean of 4629 tests per 100,000 men annually), with 80% and 59% increases in the rates TRUS-BX and incidence of PC, respectively. The highest increases in PSA screening (upto 174%) occurred in men less than 55yrs and 1,101 men had to be screened to detect one incident case of PC (0.01%). This also resulted in two thirds of men aged less than 55 receiving negative TRUS-BX. There was no correlation with Gleason >7 tumours in patients less than 55 years.
CONCLUSION: Despite the ongoing controversy on the merits of PC screening, there was an increase in PSA testing, especially in men less than 55 years leading to a modestly higher incidence of PC in Australia. Overall, PSA screening was associated with high rates of negative TRUS-BX and detection of low/intermediate grade PC among younger patients.
Written by:
Ranasinghe W, Kim SP, Lawrentschuk N, Sengupta S, Hounsome L, Barber J, Jones R, Davis P, Bolton D, Persad R. Are you the author?
Royal Melbourne Hospital/ North East Health Wangaratta, Australia.
Reference: BJU Int. 2013 Jul 8. Epub ahead of print.
doi: 10.1111/bju.12354
PubMed Abstract
PMID: 24053128
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