Prostate-specific antigen (PSA) testing is prevalent and increasing in Stockholm County, Sweden, Despite no recommendations for PSA screening: results from a population-based study, 2003-2011.
BACKGROUND
Prostate-specific antigen (PSA) testing has increased in several countries. There is incomplete knowledge of PSA testing patterns.


OBJECTIVE
Determine the prevalence of PSA testing and explore patterns of PSA retesting in Stockholm County, Sweden.


METHODS
A population-based study was performed. Through registry linkages, we collected population information, data on PSA tests, pathology reports, and clinical information. The study population comprised males living in Stockholm County in 2011 (n=1034129), of which 229 872 had a PSA test during the period 2003-2011.


METHODS
We determined limited-duration-point prevalence of PSA testing and performed survival analysis on PSA retesting for men aged 40-89 yr.


CONCLUSIONS
The number of PSA tests increased from 54239 in 2003 to 124613 in 2011. During the 9-yr study period, 46%, 68%, and 77% of men without a prior prostate cancer (PCa) diagnosis and aged 50-59 yr, 60-69 yr, and 70-79 yr, respectively, had a PSA test. During 2010 and 2011, 25%, 40%, and 46% of men aged 50-59 yr, 60-69 yr, and 70-79 yr, respectively, had a PSA test. The prevalence of PSA testing increased from 2003 to 2011. The probability of retesting was PSA and age dependent, with a 26-mo cumulative incidence of 0.337 (95% confidence interval, 0.333-0.341) if the first PSA value was <1 ng/ml. The main limitations were (1) that PSA data prior to 2003 were not available and (2) that the study cohort was restricted to men who were alive in 2011.


CONCLUSIONS
Although screening for PCa is not recommended in Sweden, PSA testing in Stockholm County was high across ages ranging from 40 to 89 yr and increased during the period 2003-2011. The probability of PSA retesting was high, regardless of the original PSA level. These results contrast with current clinical recommendations and raise calls for a change, either through structured PCa testing or more detailed guidelines on PSA testing.
Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden. tobias.nordstrom@ki.se
Tobias
T
Nordström
Markus
M
Aly
Mark S
MS
Clements
Caroline E
CE
Weibull
Jan
J
Adolfsson
Henrik
H
Grönberg
D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
D017430:Prostate-Specific Antigen