Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

2022 ◽  
Vol 77 ◽  
pp. 102093
Author(s):  
Thanya Pathirana ◽  
Rehan Sequeira ◽  
Chris Del Mar ◽  
James A. Dickinson ◽  
Bruce K. Armstrong ◽  
...  
2020 ◽  
Author(s):  
Thanya Pathirana ◽  
Rehan Sequeira ◽  
Chris Del Mar ◽  
James A Dickinson ◽  
Katy J L Bell ◽  
...  

Abstract BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA screening, prostate cancer incidence and mortality in Australia.MethodsDescription of age standardised time trends in PSA tests, prostate biopsies, cancer incidence and mortality within Australia for the age groups: 45-74, 75-84, and 85+ years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008. It then declined in men aged 45-84 years. Prostate biopsies and cancer incidence declined from 1995 to 2000, in parallel with decrease in trans-urethral resections of prostate (TURP). After 2000, changes in biopsies and cancer incidence paralleled PSA screening in men 45-84 years, while in men ≥85 years, biopsies stabilised and incidence declined. More recently a reduction in TURP correlated with increased Dutasteride and Tamsulosin usage. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until the mid 1990s, then gradually decreased. Mortality in men ≥85 years increased until the mid 1990s, then stabilised.ConclusionsAge specific prostate cancer incidence largely mirrors PSA screening rates. Most deviation may be explained by changes in management of benign prostatic disease and incidental cancer detection. The timing of the small mortality reduction in men 75-84 years is more consistent with benefits from advances in treatment than with early detection through PSA. The large increases in prostate cancer incidence with minimal changes in mortality suggest overdiagnosis.


2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 5-5
Author(s):  
David D Orsted ◽  
Borge G. Nordestgaard ◽  
Stig E. Bojesen

5 Background: It is largely unknown whether prostate-specific antigen at first date of testing predicts long-term risk of prostate cancer incidence and mortality in the general population. We tested the hypothesis that baseline prostate-specific antigen levels predict long-term risk of prostate cancer incidence and mortality. Methods: Using a prospective study, we examined 4383 20-94 year old men from the Danish general population followed in the Copenhagen City Heart Study from 1981 through 2009. Prostate-specific antigen was measured in plasma samples obtained in 1981-83. Results: During 28 years of follow-up, 170 men developed prostate cancer and 94 died from prostate cancer. Median follow-up was 18 years (range 0.5-28 years). For prostate cancer incidence, the subhazard ratio was 3.0 (95% confidence interval (CI) 1.9-4.6) for a prostate-specific antigen level of 1.01-2.00 ng/ml, 6.8 (4.2-11) for 2.01-3.00 ng/ml, 6.6 (3.4-13) for 3.01-4.00 ng/ml, 16 (10.4-25) for 4.01-10.00 ng/ml, and 57 (32-104) for >10.00 ng/ml versus 0.01-1.00 ng/ml.. For prostate cancer mortality, corresponding subhazard ratios were 2.2 (1.3-3.9), 5.1 (2.8-9.0), 4.2 (1.8-10), 7.0 (3.8-14), and 14 (6.0-32). For men with prostate-specific antigen levels of 0.01-1.00 ng/ml, absolute 10-year risk of prostate cancer was 0.6% for age <45 years, 0.7% for 45-49 years, 1.1% for 50-54 years, 1.2% for 55-59 years, 1.3% for 60-64 years, 1.1% for 65-69 years, 1.3% for 70-74 years, and 1.5% for age≥75 years; corresponding values for prostate-specific antigen levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in prostate-specific antigen at first date of testing predicted a 3-57 fold increased risk of prostate cancer, a 2-16 fold increased risk of prostate cancer mortality, and a 35-88% absolute 10-year risk of prostate cancer in those with prostate-specific antigen levels >10.00 ng/ml. Equally important, absolute 10-year risk of prostate cancer in those with levels 0.01-1.00 ng/ml was only 0.6-1.5%.


2010 ◽  
Vol 21 ◽  
pp. iii83-iii89 ◽  
Author(s):  
N. Larrañaga ◽  
J. Galceran ◽  
E. Ardanaz ◽  
P. Franch ◽  
C. Navarro ◽  
...  

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