Use of PSA testing increases by 130 percent in Sweden over 9 years

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).

6 Responses

  1. Honestly, I don’t understand the hesitancy to have men (considering age and family history and maybe regional demographics) tested in a routine fashion, especially in a country whose demographic has been associated with elevated incidences of prostate cancer. What would be the alternative approach? Would DRE and/or evidence of BPH trigger a PSA test rather than simply having it done without those indicators?

  2. Dear Anderson:

    Your have hit the nail on the head. Testing of individuals, with careful consideration of age, family history, and other factors that may affect risk, is one thing. Annual, mass, population-based screening of every man over (say) 45 years of age, regardless of age, family history, and other risk factors, is a whole other matter.


    Isn’t the real problem with mass screening that men with suspicious PSAs/DREs will prematurely rush to biopsies or to unnecessary treatment following positive biopsies?

    For men who are empowered with knowledge and support regarding when biopsies are wise and when not, and when it is or is not wise to follow positive biopsies with treatment (which is obviously where active surveillance should be considered for appropriate cases) is there any reason not to recommend screening to empowered men at appropriate ages and intervals, depending on risk factors and prior screening results?

    Granted, achieving such empowerment and support takes some doing and is far from universal or even customary in the US today.

  4. “Granted, achieving such empowerment and support takes some doing and is far from universal or even customary in the US today.”

    That is the issue of course.

  5. It becomes evident that all the controversy about screening leads to an increased awareness of prostate cancer, resulting in more men asking to be screened.

  6. It may well lead to more men asking to be “tested”. (Screening is a term properly applied to populations; testing is the appropriate term for individuals.)

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