Changes in the uptake of screening for prostate cancer with prostate-specific antigen in Ontario between 2003 to 2012

This study investigates change in prostate-specific antigen (PSA) screening uptake in Ontario among men 35 years of age and older, between 2003 and 2012. We identify factors related to PSA testing, and examine the degree to which age guidelines for PSA testing are being followed or if PSA screening is opportunistic in nature. The relationship of income, education and having a regular physician and an estimation of PSA testing prevalence in 2012 is also studied.

Data from the Canadian Community Health Survey (CCHS) were used to estimate the proportion of men who had a PSA test in 2003 and then compared to a similar estimate (in similar population) in 2012. We also examined associations with PSA uptake to socio-demographic factors. Contingency table analyses were performed to characterize the changes; logistic regression was also used to evaluate the differences, while taking into account the possible confounding role of other factors.

We found among men aged 35-49 years and 75+, there was an increase in PSA utilization between 2003 and 2012. In 2003, 18% of men 35-49 years, and 74% of men aged 75+ reported ever having a PSA test. These figures increased to 20% of men aged 35-49 years, and 84% of men aged 75+ years in 2012. Logistic regression showed that a man in the 70-74 age category in 2012 had the highest likelihood of having had a PSA test compared to men in the age range of 35-49 years (odds ratio (OR)=25.9; confidence interval (CI)= 19.9-33.8).

In Ontario, PSA testing is seemingly opportunistic in nature and occurring in groups not recommended for testing by the Ontario guidelines. There is a marked increase in PSA utilization in age ranges outside of the current Ontario PSA testing guidelines (35-49 and 75+). It would appear that most PSA testing in Ontario is opportunistic and adherence to age guidelines is limited.