Population-based prostate-specific antigen testing in the UK leads to a stage migration of prostate cancer
Moore AL et al. – Study reports that population-based prostate specific antigen (PSA) testing resulted in a significant downward stage and grade migration, and most such cancers were of low stage and grade, which could lead to risks of over-treatment for some men.Methods- Aim was to determine the stage and grade of PCa that would be found through population-based PSA testing and biopsy in UK
- Men aged 50–69 yrs from 9 cities in the UK and from randomly selected practices of general practitioners (ProtecT)
- Those with a PSA level of >3 ng/mL were offered a prostate biopsy
- Age, PSA, stage and grade at diagnosis of ProtecT participants with cancer were compared with contemporaneous incident cases aged 50–69 yrs registered at ECRIC
Results- Within ProtecT, 94,427 men agreed to be tested (50% of men contacted):
- 8,807 (~9%) had a raised PSA level
- 2,022 (23%) had prostate cancer
- 229 (~12%) had locally advanced (T3 or T4) or metastatic cancers
- Rest had clinically localized (T1c or T2) disease
- Within ECRIC, 12,661 cancers were recorded over the same period; 3714 were men aged 50-69 yrs at diagnosis
- Men in ProtecT had a lower age distribution and PSA level, and the cancers were of lower stage and grade
- If population-based PSA testing were introduced in the UK, ~2660 men per 100,000 aged 50-69 yrs would be found to have PCa, vs current rates of ~130 per 100,000
- If half of men accepted PSA testing, ~160,000 cancers would be found, compared to 30,000 diagnosed each year at present
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