Population based analysis of Prostate Specific Antigen (PSA) screening in younger men in Australia — YRD
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Population based analysis of Prostate Specific Antigen (PSA) screening in younger men in Australia (#17)

Weranja Ranasinghe 1 , Simon P Kim 2 , Nathan Lawrentschuk 3 4 , Shomik Sengupta 3 , Luke Hounsome 5 , Jim Barber 6 , Richard Jones 7 , Paul Davis 1 , Damien Bolton 3 , Raj Persad 8
  1. Royal Melbourne Hospital/North-East Health, Wangaratta, Australia
  2. Mayo Clinic, Rochester, USA
  3. University of Melbourne, Austin Hospital, Heidelberg, Australia
  4. Ludwig Cancer Institute, Melbourne, Australia
  5. South West Public Health Observatory, Bristol, UK
  6. Velindre Hospital, Cardiff, UK
  7. University of Leeds/ Leeds Teaching Hospitals Trust, Leeds, UK
  8. University Hospitals Bristol Trust, Bristol, UK

Background: Australia has the highest incidence of prostate cancer (PC) worldwide. The use of PSA as a screening tool in PC is controversial and the impact of screening men less than 55 years in Australia is unknown.

Objectives: We aimed to analyse the trends of opportunistic PSA screening in younger men in Australia and examine its effects on TRUS-BX rates and determine the nature of PCs being detected.

Methods: All men who received an opportunistic screening PSA tests and Trans-rectal ultrasound- guided biopsies (TRUS-BX) from 2001-08 in Australia were analysed using the Australian Cancer registry (Australian Institute of Health and Welfare) and Medicare databases. Victorian cancer registry was used to obtain Gleason scores. Both age-standardised and -specific rates were calculated along with incidence of PC and correlated with Gleason scores.

Results: A total 5,174,031 PSA tests detected 128,167 PC from 2001-08. During this period, PSA testing increased by 146% (a mean of 4629 tests per 100,000 men annually), with an 80% and 59% increases in the rates TRUS-BX and incidence of PC, respectively. The highest increases in PSA screening (up to 174%) occurred in men less than 55 yrs and 1,101 men had to be screened to detect one incident case of PC. This also resulted in two thirds of men aged less than 55 receiving negative TRUS-BX. There was no correlation with Gleason >7 tumours in patients less than 55 years.

Conclusion: Despite the ongoing controversy on the merits of prostate cancer screening, there was an increase in PSA testing, especially in men less than 55 years leading to a modestly higher incidence of PC in Australia. Overall, PSA screening was associated with high rates of negative TRUS-BX and detection of low/intermediate grade PC among younger patients.