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

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.