[Use of prostate-specific antigen testing]

Prostate cancer (PC) is the most frequent type of cancer among Danish men and its incidence is rising. PC is often asymptomatic, which makes it very difficult to diagnose clinically. The general practitioner can use prostate-specific antigen (PSA) testing as a diagnostic tool in PC. The use of PSA testing has been recommended by the Danish Urological Society since 1997. Our objective was to study the application and results of PSA testing in the former County of Aarhus, Denmark, in the period 1995-2006.

We extracted data from the laboratory database, LABKA, and the National Patient Registry (NPR) during the period 1995 to 2006. Data were merged by civil registration number, and the unit ordering PSA was identified as general practice or specialized healthcare system. Furthermore, we categorized samples as incident, repeated normal, repeated raised samples, or controls.

The use of PSA increased 43-fold in this period and the proportion of samples ordered by general practice increased from 38.6% (95% confidence interval: 36.4-40.8%) in 1998 to 66.1% (65.4-66.8%) in 2006. The proportion of incident samples ordered by general practice, with results below four mikromol/l increased rapidly, whereas it decreased in the specialized healthcare system. In this population, the PC incidence increased the same period, but remained stable from 2004 onwards. Furthermore, we found that the mean number of tests per man per year increased in general practice.

PSA testing in general practice is conducted more frequently, a tendency which may be explained by more check-ups after PC treatment, watchful waiting and opportunistic screening.