Opportunistic prostate cancer screening: A population-based analysis

BackgroundProstate specific antigen (PSA) utilization in population-based prostate cancer (CaP) screening, has been a controversial area for decades. Current recommendation in our region is for an opportunistic approach to screening, with estimated low prevalence of such practice in the community. However, our clinical observations suggested that the extent is beyond what might be expected from an opportunistic screening practice. This study aims to estimate the current prevalence and the extent of opportunistic CaP screening, and investigate the contemporary patterns of PSA testing in a large population.MethodsFrom 2008 to 2017, all men in the Northern cancer network of New Zealand, who had a screening PSA test performed in a community laboratory were identified. The study variables were accessed from multiple prospectively maintained databases. These included: Age, Ethnicity, Region, Social deprivation, Medical therapy, CaP history, Gleason score, and PSA test information (results and date). Population estimations were obtained from customized an updated national census data.ResultsThe study cohort constituted 311,725 men, with 1,208,214 PSA tests performed, in the ten-year period. The mean age at first test was 55.2 years and each man received approximately 4 PSA tests. The prevalence of opportunistic CaP PSA screening in men aged 40 to 79 years, was 87% of the region population. In the 50 to 69-year age group, 65% of men in the region had been receiving regular 2-yearly, screening PSA tests. Men who had 3 or more PSA tests, were more likely to be diagnosed with CaP (Odds ratio [OR] 1.85, P < 0.001).ConclusionsPSA based CaP screening, is a highly prevalent practice in the NZ community. This raises concerns regarding the quality of the individual counseling process and the adequacy of resources allocated to accommodate for such practice.