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Population-based prostate-specific antigen testing in the UK leads to a stage migration of prostate cancer
BJU International, 06/25/09

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