13 July 2021

Older Aussies at risk over high PSA uptake

Clinical Geriatric oncology Prostate cancer

Older Australian men may be at risk of unnecessary and possibly harmful treatment following inappropriate prostate cancer screening, according to an analysis of general practice data.

Contrary to guideline recommendations, the study of 180 Victorian practices found that as many as half of older asymptomatic men had a potentially unnecessary PSA test.

Researchers from Macquarie University and Outcome Health looked at the PSA testing rates of asymptomatic men over age 40 over a three-year period between 2016 and 2018.

A 2013 NHMRC evaluation of the research found that, despite its widespread use, there was no clear evidence that performing a PSA on men without symptoms reduced their risk of prostate cancer or early death.

It noted that performing the tests on asymptomatic men did carry the potential risks of overdiagnosis and overtreatment.

Current guidelines from the Cancer Council of Australia and the Prostate Cancer Foundation of Australia say that asymptomatic men who have been informed about the risks and benefits can be offered the screening test biennially between the ages of 50 and 69.

The researchers found that the proportion of men who had at least one test over the study period increased with age, peaking at around 50% in those aged 65-69.

Men aged 70-74 were most likely to have been tested twice over the three-year duration of the study, with almost one in two having at least two tests in that time.

The average PSA level rose with age, from a median of 0.7ng/mL in men aged 40–44 to 1.9ng/mL in men aged 85 years or more.

Researchers found that the proportion of men tested more than once within 24 months increased with age. Median PSA levels also increased with age, so for men over 69 years of age, this could lead to further invasive tests and treatments, some of which may be unnecessary or may cause harm.

This is the most comprehensive picture of PSA testing in asymptomatic men in Australia since the latest guidelines were released, the authors said.

“Why patterns of testing are different to those recommended (i.e., more frequently than biennial and beyond 69 years of age) cannot be explained by general practice data, but reasons may include patient expectations, fragmentation of care and the persistence of old guideline recommendations.”

MJA 2021, online July 12