The 5-year outcomes of a regional population-based PSA information and testing programme

Area of Science:

• Urology
• Public Health
• Oncology

Background:

• Population-based screening for prostate cancer using prostate-specific antigen (PSA) testing is a debated topic.
• Regional implementation of PSA testing programs requires evaluation of uptake and outcomes.

Purpose of the Study:

• To describe the outcomes of a regional mailed PSA information and testing program over its initial five years.
• To assess PSA testing rates, diagnostic activity, and cancer detection rates.

Main Methods:

• A mailed informational letter about PSA testing was sent to men aged 50-70 in Värmland, Sweden, every five years.
• Men were instructed to contact primary care for PSA testing; levels ≥3 μg/L led to urology referral.
• Local and national registers were used to track testing, diagnostics, and cancer incidence.

Main Results:

• Approximately 20% of informed men underwent PSA testing within six months, with increasing uptake over time.
• Among tested men, 3.5% had PSA ≥3 μg/L, 1.5% had biopsies, and 0.8% were diagnosed with prostate cancer.
• Yearly prostate cancer incidence increased, primarily among low- and intermediate-risk tumors, with high attendance observed.

Conclusions:

• A mailed PSA information and testing program is feasible regionally in Scandinavia and can achieve high participation.
• The rise in low-risk tumor detection necessitates caution and emphasizes the need for robust screening strategies and diagnostic algorithms to prevent overdiagnosis.