PSA-use in a Spanish industrial area

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) testing is a key tool for prostate cancer (PC) detection.
• Understanding the patterns and effectiveness of opportunistic PSA testing in the general population is crucial for public health strategies.
• Previous studies have focused on organized screening programs, with less data on real-world, non-programmatic testing.

Purpose of the Study:

• To quantify the extent of opportunistic PSA testing in the general population of Getafe, Spain.
• To evaluate the performance of this opportunistic testing in detecting prostate cancer (PC).
• To compare the effectiveness of opportunistic testing against a structured PC screening program.

Main Methods:

• Reviewed 5371 PSA test records from 1997-1999 to estimate testing rates per 1000 person-years.
• Calculated patient referral rates based on PSA levels (4-10 ng/ml and >10 ng/ml).
• Used the facility's PC screening program as a benchmark to estimate missed PC cases (Number Necessary to Screen - NNS).

Main Results:

• The overall PSA testing rate was 21.6/1000 person-years, significantly higher in older age groups (86.8/1000 for 55-69 years, 152.6/1000 for >70 years).
• PC detection rates were 4.66% for PSA 4-10 ng/ml and 12.94% for PSA >10 ng/ml.
• Opportunistic testing missed one PC for every 17 men with PSA 4-10 ng/ml and one PC for every 4 men with PSA >10 ng/ml, compared to the screening program.

Conclusions:

• Opportunistic PSA testing is highly prevalent in Getafe, particularly among older men.
• The detection rates for prostate cancer via opportunistic testing are lower than anticipated across all PSA levels.
• Opportunistic PSA testing should not be encouraged due to its suboptimal performance in PC detection.