Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: an ecological study

Area of Science:

• Urology
• General Practice
• Public Health

Background:

• Prostate-specific antigen (PSA) testing rates vary significantly in general practice.
• Understanding the impact of these variations on prostate cancer outcomes is crucial, especially where screening is not recommended.

Purpose of the Study:

• To investigate the association between PSA testing rates and prostate cancer-related outcomes in Danish general practice.
• To determine if higher PSA testing is linked to improved or adverse patient outcomes.

Main Methods:

• Utilized national registers to categorize 368 general practices into quartiles based on adjusted PSA testing rates (2004-2009).
• Analyzed associations between PSA test rates and outcomes (diagnoses, procedures, mortality) using Poisson regression for 303,098 men and 4,199 prostate cancers.

Main Results:

• Practices with the highest PSA testing rates showed increased risks of biopsy (IRR: 1.76), prostate cancer diagnosis (IRR: 1.37), and local-stage disease diagnosis (IRR: 1.61).
• Higher testing was associated with increased prostatectomy (IRR: 2.25) and radiotherapy (IRR: 1.28) rates.
• No significant differences in prostate cancer or overall mortality were observed between testing groups.

Conclusions:

• Elevated PSA testing in general practice may lead to increased diagnostic procedures and treatments without a demonstrable reduction in prostate cancer mortality.
• Findings suggest potential for overdiagnosis and overtreatment, highlighting the need for careful consideration of PSA testing protocols.