A new study in European Urology has provided information about expansion of use of the PSA test in Sweden — by some 130 percent — between 2003 and 2011. This despite the fact that (rightly or wrongly) mass population-based screening for prostate cancer is not recommended in Sweden.
The study was carried out in Stockholm County, which is the most highly populated area of Sweden with a total male population of just over 1.03 million males in 2011.
Here are the core findings of the study published by Nordström et al.:
- Of the 1 million men in Stockholm County in 2011, 229,872 (about 22 percent) were given at least one PSA test between 2003 and 2011.
- The number of PSA tests administered increased from 54,239 in 2003 to 124,613 in 2011 (a 129.7 percent increase).
- During the 9-year study period,
- 46 percent of men aged 50 to 59 years who had no prior diagnosis of prostate cancer had a PSA test.
- 68 percent of men aged 60 to 69 years who had no prior diagnosis of prostate cancer had a PSA test.
- 77 percent of men aged 70 to 79 years who had no prior diagnosis of prostate cancer had a PSA test.
- The probability of PSA retesting was PSA and age dependent, with a 26-month cumulative incidence of 0.337 (range, 0.333-0.341) if the first PSA value was < 1 ng/ml.
It is hard to know exactly what to do with data like this, but it is clear that despite the fact that prostate cancer screening is not recommended, PSA testing is now considered reasonable by > 50 percent of all men between 50 and 79 years of age (and presumably their doctors) in the major urban area of Sweden.
The authors conclude that “These results contrast with current clinical recommendations and raise calls for a change, either through structured [prostate cancer] testing or more detailed guidelines on PSA testing.” There are no data available — yet — through which to assess the implications of this increase in testing (in terms of the potential for actually eliminating prostate cancer in men who really do need treatment and/or causing harm through the over-treatment of men who likely do not need treatment).