PSA-Screening: Sinnvoll oder Geldvernichtung?

Peter Hammerer

doi:10.1055/a-1240-8583

PSA-Screening: Sinnvoll oder Geldvernichtung?

Der Klinikarzt ◽

10.1055/a-1240-8583 ◽

2020 ◽

Vol 49 (07/08) ◽

pp. 335-341

Author(s):

Peter Hammerer

Keyword(s):

Psa Test ◽

Oder Eine ◽

Psa Screening ◽

Klinische Parameter

ZUSAMMENFASSUNGIn Deutschland kommen derzeit 2 Früherkennungsverfahren für Prostatakrebserkrankungen zum Einsatz: die digital-rektale Untersuchung (DRU) und der Bluttest zur Messung von PSA. Während die DRU im gesetzlichen Früherkennungsangebot für Männer ab 45 Jahren enthalten ist und somit erstattet wird, steht der PSA-Test ausschließlich als individuelle Gesundheitsleistung zur Verfügung.PSA ist ein Eiweiß, welches in der Prostata gebildet und in die Samenflüssigkeit abgegeben wird. Ein erhöhter PSA-Wert im Serum kann auf eine Prostatakrebserkrankung hinweisen, kann aber auch durch andere Ursachen wie eine Entzündung der Prostata oder Blase oder eine gutartige Vergrößerung der Prostata bedingt sein. Üblicherweise wird der PSA-Wert mit anderen klinischen Parametern kombiniert, um so eine Risikoabschätzung für eine Prostatakrebserkrankung zu ermöglichen.Das IQWIG hat aktuell ein Gutachten zum Thema Prostatakrebsscreening mittels PSA-Test erstellt, das Fazit lautete: „Das Prostatakarzinomscreening mittels PSA-Test schadet deutlich mehr Männern durch Überdiagnosen als es Männern nutzt. Daher wird zusammenfassend festgestellt, dass der Nutzen des Prostatakarzinomscreenings mittels PSA-Test den Schaden nicht aufwiegt.“Viele Fachgesellschaften haben diese Bewertung kritisiert, da diese dazu führen könne, dass Männer Früherkennungsuntersuchungen eher vermeiden und in der Konsequenz langjährige Belastungen durch Metastasen, lokale Symptome und Behandlungsfolgen durch Chemotherapien sowie die Mortalität zukünftig stark zunehmen können.Fazit: Der PSA-Test kann Männer davor bewahren, an Prostatakrebs zu versterben. Allerdings sollten neben dem PSA-Wert klinische Parameter in die Bewertung mit einbezogen werden. Das Risiko eines alleinigen PSA-Testes ist die geringe Spezifität und die dadurch bedingte Verunsicherung und mögliche Überbehandlung.

Download Full-text

Das Prostatakarzinom: aktuelle Diagnostik und Therapiestandard

Praxis ◽

10.1024/1661-8157/a002437 ◽

2016 ◽

Vol 105 (16) ◽

pp. 971-977

Author(s):

Jan Brachlow ◽

Martin Kälin ◽

Marco Randazzo ◽

Beat Förster ◽

Hubert John

Keyword(s):

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Psa Test ◽

Eine Hohe ◽

Psa Screening ◽

Sekundäre Hormontherapie

Zusammenfassung. Das Prostatakarzinom zeigt eine hohe Prävalenz und ist daher für die behandelnden Ärzte medizinisch, aber auch gesundheitspolitisch relevant. PSA-Screening senkt die karzinomspezifische Mortalität, ist jedoch aufgrund der hohen Prävalenz mit einer Überdiagnostik verbunden. Dies fordert im Gegenzug einen verantwortungsbewussten Umgang mit dem PSA-Test («smarter screening»). Durch die robotergestützte Prostatektomie steht eine Therapie mit geringer Morbidität zur Behandlung des lokalisierten Prostatakarzinoms zur Verfügung. Das fokale Behandlungskonzept der HIFU (high-intensity focused ultrasound) ist vielversprechend, jedoch noch klinisch experimentell und sollte im Rahmen von Studien angeboten werden. Die Behandlungsmöglichkeiten beim metastasierten Prostatakarzinom wurden entscheidend vervielfältigt. Chemotherapie und die sekundäre Hormontherapie werden voraussichtlich vermehrt in früheren Phasen der Krankheit eine Rolle spielen, wodurch die Therapie für den einzelnen Patienten immer komplexer wird und individuell angepasst werden muss.

Download Full-text

Patient Provider Continuity and Prostate Specific Antigen Testing: Impact of Continuity on Receipt of a Non-recommended Test

Frontiers in Medicine ◽

10.3389/fmed.2021.622541 ◽

2021 ◽

Vol 8 ◽

Author(s):

Arch G. Mainous ◽

Benjamin J. Rooks ◽

Elvira S. Mercado ◽

Peter J. Carek

Keyword(s):

Prostate Specific Antigen ◽

Continuity Of Care ◽

Specific Antigen ◽

Behavioral Risk ◽

Psa Test ◽

Advantages And Disadvantages ◽

Psa Screening ◽

Personal Doctor ◽

Nationally Representative ◽

To Receive

Background: Continuity of care with a regular physician has been associated with treatment adherence but it is unclear if continuity of care may lead to inappropriate treatments. We assessed the relationship between the receipt of prostate-specific antigen (PSA) screening, a non-recommended test, and having continuity with a single personal doctor.Methods: We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). Responses from men aged 40 and older with no symptoms or family history of prostate cancer were analyzed (unweighted n = 232,548, representing 36,919,766 individuals). Continuity with one doctor was analyzed in relation to discussions of advantages and disadvantages of PSA tests, provider recommendation to receive a test and receipt of a PSA test.Results: 39.5% of men received PSA screening during the time that the test was not recommended. Having a single personal doctor was associated with discussion of both advantages (53.3 vs. 29.7%, p < 0.001) and disadvantages (24.2 vs. 13.5%, p < 0.001) of PSA tests but also a recommendation to receive a PSA test (45.3 vs. 29.3%, p < 0.001). The adjusted odds of receiving a PSA test was higher among those with a single personal doctor compared to those without (OR 2.31; 95% CI, 2.17–2.46).Conclusion: In a nationally representative sample during the time when PSA screening was not recommended by the US Preventive Services Taskforce, having a single personal doctor was associated with both recommendations for the test and receipt of the test. These findings emphasize the importance of the patient physician relationship and the need for evidence-based care.

Download Full-text

Are Men Making Informed Decisions According to the Prostate-Specific Antigen Test Guidelines? Analysis of the 2015 Behavioral Risk Factor Surveillance System

American Journal of Men s Health ◽

10.1177/1557988319834843 ◽

2019 ◽

Vol 13 (2) ◽

pp. 155798831983484 ◽

Cited By ~ 2

Author(s):

Dexter L. Cooper ◽

Latrice Rollins ◽

Tanesha Slocumb ◽

Brian M. Rivers

Keyword(s):

Prostate Specific Antigen ◽

Surveillance System ◽

Specific Antigen ◽

Future Research ◽

Behavioral Risk ◽

Adult Males ◽

Psa Test ◽

Advantages And Disadvantages ◽

Psa Screening ◽

Chi Square Analysis

The prostate-specific antigen (PSA) screening recommendation endorses the opportunity for men to make an informed decision about whether or not to screen. This entails speaking with a provider to discuss the potential advantages, disadvantages, and uncertainties about the PSA screening test. The purpose of this study was to examine (a) the reported level of being informed about the PSA test by race and (b) the association between the receipt of the PSA test and participants reporting that they were informed about the test. U.S. adult males (ages 40–74 years) were identified from the 2015 Behavioral Risk Factors Surveillance System (BRFSS; n = 3,877). Chi-square analysis assessed bivariate differences among men who received different levels of PSA screening information. Binomial logistic regression models assessed the relationship of race/ethnicity and the receipt of the PSA test on being informed about the PSA test. Over half (54.3%) of the sample had a PSA test and most (72.0%) reported that they did not receive information about both the advantages and disadvantages (being informed) of the PSA test. Black men (40.3%) were significantly most likely to report being informed ( p < .001), and 61.3% reported receipt of a recommendation from their provider ( p < .001). White men (63.1%) were significantly more likely to report receiving the PSA test. Findings indicate that more men reported receiving the PSA test than men who reported being informed about it. Future research and interventions should strive for men of all racial and ethnic backgrounds to be informed about the PSA test before making a decision.

Download Full-text

PSA testing in general practice

Journal of Primary Health Care ◽

10.1071/hc12199 ◽

2012 ◽

Vol 4 (3) ◽

pp. 199 ◽

Cited By ~ 9

Author(s):

Fraser Hodgson ◽

Zuzana Obertová ◽

Charis Brown ◽

Ross Lawrenson

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Age Groups ◽

Psa Test ◽

Psa Screening ◽

Psa Testing ◽

Asymptomatic Patients ◽

Keywords Prostate ◽

General Practices

INTRODUCTION: In New Zealand, prostate-specific antigen (PSA) testing has increased significantly (275 000 tests/year). Controversy exists around PSA testing as part of an unorganised screening programme. AIM: To look at the use of PSA testing in a sample of general practices and investigate the reasons GPs undertake PSA testing. METHODS: Five Waikato general practices investigated looking at PSA laboratory tests of men =40 years in 2010 compared against GP notes. Testing rates, reasons for testing, histology and referral/s were examined for different age groups. A questionnaire was sent to the GPs to determine their views on PSA testing. RESULTS: One in four men aged 40+ years had a PSA test in 2010. Of these men, 71% were asymptomatic. More than half of men tested aged 70+ years were asymptomatic. Ten percent of all PSA tests were elevated. Twenty-one of 23 prostate cancers were diagnosed following an elevated PSA test: more than 80% of these men had histories of prostate pathology or lower urinary tract symptoms. The questionnaire confirmed that GPs believe in the benefits of PSA screening and it also showed they had difficulty in providing patients with information about pros and cons of PSA testing. DISCUSSION: All GPs in this study tested asymptomatic men. GPs in this study value PSA screening and believe that it reduces mortality rates. However, although PSA tests were most frequently done on asymptomatic patients, the majority of patients subsequently diagnosed with prostate cancer had been tested because of symptoms or had previous prostate problems. KEYWORDS: Prostate specific antigen (PSA); PSA testing; screening; prostate cancer; general practitioners

Download Full-text

Factors associated with PSA testing in men ≥ 50 years in Ireland

European Journal of Public Health ◽

10.1093/eurpub/ckab165.143 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

R O'Donovan ◽

P Fitzpatrick

Keyword(s):

Prostate Cancer ◽

Screening Programme ◽

Population Based ◽

Older Age ◽

Related Factors ◽

Psa Test ◽

Psa Screening ◽

Psa Testing ◽

Increased Risk ◽

Health Related

Abstract Background Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland. Methods A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest. Results There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78). Conclusions High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing. Key messages Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed.

Download Full-text

Prostate-Specific Antigen Screening According to Health Professional Counseling and Age in the United States

Prostate Cancer ◽

10.1155/2022/8646314 ◽

2022 ◽

Vol 2022 ◽

pp. 1-9

Author(s):

Ray M. Merrill ◽

Seth A. Otto ◽

Eliza B. Hammond

Keyword(s):

Health Professional ◽

Task Force ◽

Specific Antigen ◽

The United States ◽

Screening Methods ◽

Professional Counseling ◽

Psa Test ◽

Psa Screening ◽

The Past ◽

The Us

Background. In 2018, the US Preventive Services Task Force recommended that PSA screening for prostate cancer involve men aged 55–69, based on a personal decision following consultation with a health professional. PSA screening in men aged 70 or older should only occur if symptoms exist. This study identifies the association between having a PSA test in the past two years and whether or not there was consultation with a health professional about the benefits and/or harms of PSA screening. Methods. Analyses were based on data involving men aged 40 years or older, who responded to PSA related questions in the 2018 BRFSS survey. Results. Approximately 32.0% (14.6% for ages 40–54, 41.7% for ages 55–69, and 49.8% for ages 70 years and older) of respondents had a PSA test in the past two years. Approximately 81.7% of these men had talked with a health professional about the benefits and/or harms of PSA screening, with 42.4% having discussed the benefits and harms, 54.6% having discussed the benefits only, and 3.0% having discussed the harms only. The odds of a PSA test in the past two years in men having talked with a health professional about the benefits and harms of the test versus no talk are 10.1 (95% CI 9.3–10.8), in men who talked with a health professional about the benefits only versus no talk are 10.8 (95% CI 10.0–11.6), and in men who talked with a health professional about the harms only versus no talk are 3.9 (95% CI 2.9–5.1). Conclusion. PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation. Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms.

Download Full-text

The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study

Scientific Reports ◽

10.1038/s41598-021-81459-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Abraham M. Getaneh ◽

Eveline A. M. Heijnsdijk ◽

Harry J. de Koning

Keyword(s):

Prostate Cancer ◽

Prostate Cancer Screening ◽

Population Based ◽

Cancer Death ◽

Resonance Imaging ◽

Psa Test ◽

Prostate Cancer Mortality ◽

Psa Screening ◽

Regular Screening ◽

Life Years

AbstractThe benefit of prostate cancer screening is counterbalanced by the risk of overdiagnosis and overtreatment. The use of a multi-parametric magnetic resonance imaging (mpMRI) test after a positive prostate-specific antigen (PSA) test followed by magnetic resonance imaging-guided biopsy (MRIGB) may reduce these harms. The aim of this study was to determine the effects of mpMRI and MRIGB vs the regular screening pathway in a population-based prostate cancer screening setting. A micro-simulation model was used to predict the effects of regular PSA screening (men with elevated PSA followed by TRUSGB) and MRI based screening (men with elevated PSA followed by mpMRI and MRIGB). We predicted reduction of overdiagnosis, harm-benefit ratio (overdiagnosis per cancer death averted), reduction in number of biopsies, detection of clinically significant cancer, prostate cancer death averted, life-years gained (LYG), and quality adjusted life years (QALYs) gained for both strategies. A univariate sensitivity analysis and threshold analysis were performed to assess uncertainty around the test sensitivity parameters used in the MRI strategy.In the MRI pathway, we predicted a 43% reduction in the risk of overdiagnosis, compared to the regular pathway. Similarly a lower harm-benefit ratio (overdiagnosis per cancer death averted) was predicted for this strategy compared to the regular screening pathway (1.0 vs 1.8 respectively). Prostate cancer mortality reduction, LY and QALYs gained were also slightly increased in the MRI pathway than the regular screening pathway. Furthermore, 30% of men with a positive PSA test could avoid a biopsy as compared to the regular screening pathway. Compared to regular PSA screening, the use of mpMRI as a triage test followed by MRIGB can substantially reduce the risk of overdiagnosis and improve the harm-benefit balance, while maximizing prostate cancer mortality reduction and QALYs gained.

Download Full-text

Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims data

Australian Health Review ◽

10.1071/ah13092 ◽

2013 ◽

Vol 37 (5) ◽

pp. 649 ◽

Cited By ~ 7

Author(s):

Judy A. Trevena ◽

Kris D. Rogers ◽

Louisa R. Jorm ◽

Tim Churches ◽

Bruce Armstrong

Keyword(s):

Prostate Specific Antigen ◽

Test Item ◽

Screening Test ◽

Claims Data ◽

Specific Antigen ◽

Psa Test ◽

Australian Health ◽

Psa Screening ◽

Episode Of Care ◽

Medical Benefits

Objective We investigated the completeness of recording of pathology tests in Australian Medical Benefits Schedule (MBS) claims data, using the example of the prostate-specific antigen (PSA) test. With some exceptions, MBS claims data records only the three most expensive pathology items in an episode of care, and this practice (‘episode coning’) means that pathology tests can be under-recorded. Methods The analysis used MBS data for male participants in the 45 and Up Study. The number and cost of items in each episode of care were used to determine whether an episode contained a PSA screening test (Item 66655), or could have lacked a record of this item because of episode coning. Results MBS data for 1 070 392 episodes involving a request for a pathology test for 118 074 men were analysed. Of these episodes, 11% contained a request for a PSA test; a further 7.5% may have been missing a PSA request that was not recorded because of episode coning. Conclusions It is important to consider under-reporting of pathology tests as a result of episode coning when interpreting MBS claims data. Episode coning creates uncertainty about whether a person has received any given pathology test. The extent of this uncertainty can be estimated by determining the proportion of episodes in which the test may have been performed but was not recorded due to episode coning. What is known about the topic? Medical Benefits Schedule (MBS) claims data are a key resource for Australian health researchers. What does this paper add? We investigated a feature of MBS claims data known as episode coning, which may cause some pathology tests to be under-reported. Using the example of requests for PSA tests, we estimated the uncertainty in the amount of use of PSA tests introduced by episode coning. What are the implications for practitioners? Researchers using MBS data to identify use of specific pathology tests need to be aware of under-reporting caused by episode coning, and to estimate and report the uncertainty that this introduces into their findings.

Download Full-text