Prostate cancer testing (and diagnosis) in the UK in 2007

A recently published study reports on the incidence of PSA testing in the United Kingdom (UK) in 2007. There is no national recommendation for prostate cancer testing (i.e., “screening”) in the UK. However, PSA testing is covered by National Health Service; men who request a PSA test will normally be given one by their family doctor.

For the period from 2001 to 2007, the annual rate of  PSA testing in the UK had been estimated at about 6 percent per year among men aged from 45 to 84 years. Williams et al. set out to estimate rates of PSA testing in “general practices’ (i.e., community-based family practices) by age, “deprivation index,” and geographical location. (The “deprivation index” is a measure of the socioeconomic status of the population being served by a particular family practice.)

Williams et al. collected clinical practice-based, retrospective data on PSA testing patterns in 2007 from a random sample of 87 general practices in six English cities (three cities in the north of England and three in the south). The data collected was based on a total of 126,716 men aged between 45 and 89 years who had no recorded diagnosis of prostate cancer prior to 1 January 2007. Analysis of these data offered the following insights:

  • 7,902/126,716 men (6.2 percent) with no a prior diagnosis of prostate cancer had at least one PSA test from their general practitioner during 2007.
  • PSA testing rates were 1.4 percent in men aged 45 to 49 years and rose to 11.3 percentin men aged 75-79 years.
  • Testing rates in the three northern centres ranged from 3.5 to 5.7 percent.
  • Testing rates in the three southern cities  ranged from 7.1 to 8.9 percent.
  • For every 20-point increase in the “deprivation index,” the proportion of men tested fell by 1.7 percent.
  • Lower proportions of men were subsequently diagnosed with prostate cancer in practices testing more men.

The authors draw a series of conclusions from this study, as follows:

  • Overall levels of PSA testing by general practitioners in the UK remain low.
  • Where testing is taking place, there are important variations by age, deprivation and geographical location.
  • PSA testing in general practices is skewed towards older men.
  • Current national policy enabling all men to make an informed choice about PSA testing is not being effectively implemented.

They go on to argue that these data emphasize the need for robust evidence regarding the costs and benefits of using the PSA test for the detection of localized prostate cancer in the UK, a full assessment of the health economic implications, and a revision of the current national policy on PSA testing.

It is worth noting that the idea that one should have an annual health check-up at all is not exactly embraced by the average male in the UK. The “New” Prostate Cancer InfoLink does not have data on the proportion of men in the UK who see their doctor on a regular basis for such a health check, but we would not be at all surprised to learn that for men between the ages of 25 and 65 in the UK it might well be very low indeed. Maybe even as low as 10 percent. This certainly has some impact on the likelihood of PSA testing in a key sector of the potential target audience. Having said that, we do find it interesting that among the clinical practices where the use of PSA testing appears to have been higher, the occurrence of a subsquent diagnosis of prostate cancer appeasr to be reduced (as a percentage of the number of men tested).

One Response

  1. With prostate cancer being less prominent than cardio disease and some other causes of death and illness, that low rate of check-ups is probably contributing to higher rates of illness and death from all causes.

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