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04-08-2013 | Urology | Article

Primary care PSA testing falls after study results


Free abstract

medwireNews: Research from the Netherlands shows that primary care prostate-specific antigen (PSA)-testing rates significantly fell following publication of the European Randomized Study for Prostate Cancer (ERSPC) results.

The current findings, reported by Marco Blanker (University of Groningen, the Netherlands) and colleagues, also raise concerns that the rate of follow-up testing in men with abnormal results also declined to inadequate levels.

The ERSPC, which was sent to all Dutch general practitioners (GPs) upon publication in 2009, reported only a 20% decrease in prostate cancer mortality, leading to strong advice against PSA testing from the Dutch College of GPs (NHG).

“Although the present study was not designed to establish a causal relationship, we think that this decrease in PSA testing can largely be explained by the impact of the ERSPC publication on GP’s testing rates, as no other factors could be identified,” say Blanker and team.

The researchers analyzed data from an insurance claims database that included around 715,000 men aged 40 years or more, of whom 66,848 had a primary PSA test requested by their GP from 2008 onwards.

This showed that around 4 months following the publication of ERSPC, there was a significant decline in the number of PSA tests, from 33.1 per 1000 men before, to 27.5 per 1000 men after publication.

Blanker and team also used laboratory data from a large district hospital for 9766 primary PSA test requests from GPs between 2006 and 2011. These data reveal that the repeat testing rate within 1 year of the ERSPC being published also fell significantly, from 38.5% to 26.5%. In particular, it fell by nearly 50% among men aged 40 to 50 years, and 50 to 60 years, while only a minimal decline was observed in men aged 70 to 80 years.

Worryingly, repeat testing in men within the critical PSA range of 4 to 10 ng/mL also decreased, from 65.3% to 52.2%. And, while repeat testing increased among men with PSA levels over 10 ng/mL, from 73.8% to 82.0%, referrals were reduced in this group.

“As abnormal PSA levels coincide with an increased chance of prostate cancer, it was surprising to see that GPs refrained from repeating such a test,” comment the authors in BJU International.

“The reasons for this remain unclear, but the NHG advice on restrained PSA use could be an influence,” they suggest.

They recommend that GPs use the Prostate Cancer Research Foundation prostate cancer risk calculator to help determine their policy for follow-up testing.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter