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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| Published in: | BJU international Vol. 133; no. 1; pp. 104 - 111 |
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| Main Authors: | , , , , , , |
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| Language: | English |
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01.01.2024
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| ISSN: | 1464-4096, 1464-410X, 1464-410X |
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| Abstract | 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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| AbstractList | ObjectiveTo describe age‐specific prostate‐specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population‐wide opportunistic PSA testing.Patients and MethodsOver 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.ResultsThe 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.ConclusionOpportunistic 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. To describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide opportunistic PSA testing.OBJECTIVETo describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide opportunistic PSA testing.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.PATIENTS AND METHODSOver 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.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.RESULTSThe 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.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.CONCLUSIONOpportunistic 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. To describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide opportunistic PSA testing. 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. 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. 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. 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. 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. |
| Author | Fosså, Sophie Pasovic, Lara Müller, Stig Albertsen, Peter C. Carlsson, Sigrid V. Oldenburg, Jan Bjerner, Lars Johan |
| AuthorAffiliation | 3 Department of Urology, Akershus University Hospital, Lørenskog, Norway 4 Medical Faculty, University of Oslo, Oslo, Norway 1 Department of Surgery (Urology), UConn Health, Farmington, CT, USA 2 Fürst Laboratories, Department of Clinical Chemistry, Oslo, Norway 6 Department of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA 5 Oslo University Hospital Department of Oncology 7 Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden 8 Department of Oncology, Akershus University Hospital, Lørenskog, Norway |
| AuthorAffiliation_xml | – name: 3 Department of Urology, Akershus University Hospital, Lørenskog, Norway – name: 2 Fürst Laboratories, Department of Clinical Chemistry, Oslo, Norway – name: 5 Oslo University Hospital Department of Oncology – name: 8 Department of Oncology, Akershus University Hospital, Lørenskog, Norway – name: 1 Department of Surgery (Urology), UConn Health, Farmington, CT, USA – name: 4 Medical Faculty, University of Oslo, Oslo, Norway – name: 6 Department of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA – name: 7 Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden |
| Author_xml | – sequence: 1 givenname: Peter C. surname: Albertsen fullname: Albertsen, Peter C. email: albertsen@uchc.edu organization: UConn Health – sequence: 2 givenname: Lars Johan surname: Bjerner fullname: Bjerner, Lars Johan organization: Fürst Laboratories – sequence: 3 givenname: Lara surname: Pasovic fullname: Pasovic, Lara organization: Akershus University Hospital – sequence: 4 givenname: Stig surname: Müller fullname: Müller, Stig organization: University of Oslo – sequence: 5 givenname: Sophie surname: Fosså fullname: Fosså, Sophie organization: Oslo University Hospital – sequence: 6 givenname: Sigrid V. surname: Carlsson fullname: Carlsson, Sigrid V. organization: Sahlgrenska Academy at Gothenburg University – sequence: 7 givenname: Jan surname: Oldenburg fullname: Oldenburg, Jan organization: Akershus University Hospital |
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To describe age‐specific prostate‐specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population‐wide... To describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide opportunistic... ObjectiveTo describe age‐specific prostate‐specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population‐wide... Objective To describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide... |
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| SubjectTerms | 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 |
| Title | Opportunistic prostate‐specific antigen testing in Norwegian men: a public health challenge |
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