PSA testing and digital rectal examination in New Zealand

OBJECTIVE: To investigate the use of digital rectal examination and prostate specific antigen (PSA) testing in a population-based sample of men in New Zealand. METHODS: A random selection of men aged 40-74 years, weighted by age, was chosen from the general electoral roll of New Zealand. Only men with a telephone who had been married at some time were eligible. Telephone interviews were conducted using a standard questionnaire. Crude and age-adjusted proportions were calculated. Logistic regression was used to explore associations between sociodemographic factors and digital rectal examination or PSA testing. RESULTS: Interviews were completed for 85% of the 1,486 eligible men and analyses were confined to the 1,225 European men. Many more men reported having a digital rectal examination (41%; 95% CI 33.8-48.2) than a PSA test (9%; 95% CI 4.2-14.2). Men in the lowest social class were significantly less likely to have had a digital rectal examination (OR 0.30; 95% CI 0.18-0.50) or PSA test (OR 0.25; 95% CI 0.11-0.60) compared with those in the highest social class. Men with vocational training or no post-school qualifications were approximately half as likely to report a digital rectal examination or a PSA test compared with men with degrees or diplomas. CONCLUSIONS: Although current New Zealand recommendations are that population screening for prostate cancer should not be introduced, many men are still having digital rectal examinations and PSA tests in the absence of symptoms. The frequency of PSA testing is considerably lower than in Australia and appears to be largely influenced by a man's social class.     

PSA testing: Molecular technologies and men's experience of prostate cancer survivorship

Although the value of the PSA (prostate-specific antigen) test as a cancer-screening instrument remains hotly contested, over the past two decades its usage has become commonplace. While most men diagnosed with prostate cancer will die with rather than of the disease, widespread PSA screening has led to an attendant increase in cancer diagnoses and the usage of aggressive treatments to ‘combat’ it. Despite the central (if controversial) role that PSA now plays in the diagnosis of prostate cancer and monitoring for recurrence, few studies have set out to explore its role in men's experiences of the disease. Drawing on ethnographic fieldwork at a prostate cancer support group in western Canada, we seek to delineate the meanings the PSA test holds for prostate cancer survivors. For many men in the study, their PSA levels were seen to provide an objective indicator of the presence or absence of cancer, with important implications for their subjective experience of cancer diagnosis and survivorship.     

Risk management. Discussing benefits and risks with patients. PSA testing

Obtaining valid consent from patients is good medical practice and a legal necessity. The process of obtaining consent involves shared decision making and a discussion of benefits and risks with patients. This article uses the example of PSA screening to explore the issue of shared decision making and outlines some strategies for general practitioners to use when discussing risks with patients.     

PURLs: PSA testing: when it's useful, when it's not

Routine PSA testing leads to more diagnoses of prostate cancer, but does not save lives. At least one group of men, however, may reap a small benefit.     

血清中游离与总前列腺特异性抗原的临床应用

前列腺癌是男性泌尿系统常见的恶性肿瘤,在欧美占男性癌症死亡率的第二位.在中国,随着人口的老龄化及饮食结构的改变,前列腺癌发病率逐年上升.由于前列腺癌早期症状隐蔽,早期诊断较困难,待确诊时约有80%的病人已有不同程度的局部或远处转移,早期诊断将有助于生存率的提高.     

Screening in Austria: the cases of mammography, PSA testing, and routine use of ultrasound in pregnancy

OBJECTIVE: To study cases of screening in Austria to learn about national strategies to handle the health policy challenge of early detection of widespread diseases and about the outcome of those strategies. The article describes three healthcare interventions (mammography, PSA testing, and routine use of ultrasound in pregnancy) and the instruments of Austrian health policy that are used-with or without explicit intention-to enforce or to control the widespread use of (early) diagnoses. METHODS: Data and information collection on healthcare services, their accessibility, rate of use, expert consensus, and official regulations. For all three case studies, expert interviews were carried out with main actors. RESULTS: Risk-group screening is not a priority in Austrian federal health policy. Although health promotion and prevention is a national task, examinations for early detection of specific diseases (i.e., carcinoma) are left to the health insurance funds, which delegate the decision to offer early diagnoses to their contracted physicians. In this opportunistic screening, general practitioners or specialists are encouraged by their health insurance funds or motivated by professional guidelines to offer certain examinations. CONCLUSIONS: Screening is a coordinated effort to acquire a grasp of a common disease at an early stage in a specified population. To achieve this objective, a culture of coordination and centralization has to be implemented. The collection of data is an essential element in coordination of decentralized medical interventions as much as quality control is an essential task in looking at and comparing the outcome of interventions. In the three case studies, neither of these two essential criteria were met. Evaluations and scientific evidence on the effectiveness of interventions were not used.