Prostate Specific Antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study

Objectives: Cross-sectional studies suggest that around 6% of men undergo PSA testing each year in UK general practice. This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer.

Setting, participants and outcome measures: Patient-level data on PSA tests, biopsies and prostate cancer (PCa) diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man’s age, region and index of multiple deprivation (IMD) with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared to those from the programme of PSA testing in the ProtecT study.

Results: The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK general practice was 39.2% (95% C.I. 39.0, 39.4%). The age-specific risks ranged from: 25.2% for 45-49 year olds to 53.0% for 65-69 year olds (P for trend<0.001). For those with a PSA level ≥3, a test in UK general practice was less likely to result in a biopsy (6%) and/or diagnosis of prostate cancer (15%) compared to ProtecT study participants (85% and 34% respectively).

Conclusion: A high proportion of 45-69 year old men undergo PSA tests in UK general practice: 39% over a ten year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms, and not screening for prostate cancer.