Opportunistic prostate‐specific antigen testing in Norwegian men: a public health challenge

Objective To describe age‐specific prostate‐specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population‐wide opportunistic PSA testing. Patients and Methods Over 8 million PSA tests were performed on >1.4 million Norwegian men from 2000 to 2020. During...

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Bibliographic Details
Published in:BJU international Vol. 133; no. 1; pp. 104 - 111
Main Authors: Albertsen, Peter C., Bjerner, Lars Johan, Pasovic, Lara, Müller, Stig, Fosså, Sophie, Carlsson, Sigrid V., Oldenburg, Jan
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01.01.2024
Subjects:
Age
Aged
Aging
Antigens
Biopsy
cancer mortality
cancer screening
Humans
Male
Mass Screening
Medical diagnosis
Middle Aged
Nephrology
Njurmedicin
population
Prostate cancer
prostate cancer mortality
Prostate-Specific Antigen
Prostatic Neoplasms - diagnosis
Prostatic Neoplasms - epidemiology
PSA
Public Health
serum
Urology & Nephrology
prostate cancer
cancer screening
prostate cancer mortality
public health
PSA
ISSN:1464-4096, 1464-410X, 1464-410X
Online Access:Get full text
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Summary:Objective To describe age‐specific prostate‐specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population‐wide opportunistic PSA testing. Patients and Methods Over 8 million PSA tests were performed on >1.4 million Norwegian men from 2000 to 2020. During this period 43 486 men were diagnosed with localised prostate cancer. Most of the PSA testing reflected opportunistic testing. Age‐specific PSA value distributions were constructed for men aged 45–75 years with and without prostate cancer. Results The distributions of PSA values in men with and without prostate cancer widened with age and overlapped extensively from 3 to 7 ng/mL. Localised prostate cancer diagnoses increased 10‐fold from the age of 45 to 75 years. PSA testing identified intermediate‐ or high‐grade cancers in 21% (95% confidence interval [CI] 19–23%) of men aged 50–54 years and 42% (95% CI 41–43%) of men aged 70–74 years. Grade group (GG)1, GG2, GG3 and ≥GG4 constituted 49%, 31%, 10% and 10% of cancers identified at age 50–54 years and 26%, 26%, 18%, and 30% of cancers identified at age 70–74 years. Conclusion Opportunistic PSA testing increases with ageing and often generates values that cannot discriminate benign prostate enlargement from prostate cancer. A clinical cascade using additional imaging or serum tests is necessary to avoid negative biopsies and the overdiagnosis of indolent disease. The declining specificity of PSA testing with ageing poses a significant public health challenge especially among older men aged ≥70 years.
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ISSN:1464-4096
1464-410X
1464-410X
DOI:10.1111/bju.16211