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Prostate specific antigen retesting intervals and trends in England: population based cohort study.

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Prostate specific antigen (PSA) testing in England shows significant variation, with many patients undergoing frequent retesting, raising concerns about overtesting. Further research is needed to establish evidence-based PSA retesting intervals for optimal patient benefit and reduced risk.

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Area of Science:

  • Urology
  • Primary Care Medicine
  • Health Services Research

Background:

  • Prostate specific antigen (PSA) testing is a key tool in prostate cancer diagnostics.
  • Understanding PSA testing patterns in primary care is crucial for appropriate utilization.

Purpose of the Study:

  • To characterize the utilization of PSA testing within England's primary care system.
  • To identify trends and factors influencing PSA test frequency and retesting intervals.

Main Methods:

  • A population-based, open cohort study utilizing data from 1442 general practices in England (2000-2018).
  • Linked data from the National Cancer Registry, Hospital Episode Statistics, and Office for National Statistics.
  • Analysis included temporal trends, age-standardized rates, and mixed-effects models to examine testing and retesting intervals based on various patient and clinical factors.

Main Results:

  • Over 1.5 million patients received more than 3.8 million PSA tests.
  • A significant proportion (48.4%) had multiple tests, with many (72.8%) never exceeding the referral threshold.
  • Median retesting interval was 12.6 months, with variations observed based on age, ethnicity, family history, and PSA levels, though intervals were similar across regions and deprivation levels.

Conclusions:

  • PSA testing practices in primary care in England are variable.
  • Concerns exist regarding overtesting, as many patients with multiple tests are retested more frequently than recommended, sometimes without symptoms or with low PSA values.
  • There is an urgent need for research to establish evidence-based PSA retesting intervals to maximize patient benefit and minimize overtesting risks.