Prostate-specific antigen (PSA) testing is prevalent and increasing in Stockholm County, Sweden, Despite no recommendations for PSA screening: results from a population-based study, 2003-2011

Background: Prostate-specific antigen (PSA) testing has increased in several countries. There is incomplete knowledge of PSA testing patterns.

Objective: Determine the prevalence of PSA testing and explore patterns of PSA retesting in Stockholm County, Sweden.

Design, setting, and participants: A population-based study was performed. Through registry linkages, we collected population information, data on PSA tests, pathology reports, and clinical information. The study population comprised males living in Stockholm County in 2011 (n=1034129), of which 229 872 had a PSA test during the period 2003-2011.

Outcome measurements and statistical analysis: We determined limited-duration-point prevalence of PSA testing and performed survival analysis on PSA retesting for men aged 40-89 yr.

Results and limitations: The number of PSA tests increased from 54239 in 2003 to 124613 in 2011. During the 9-yr study period, 46%, 68%, and 77% of men without a prior prostate cancer (PCa) diagnosis and aged 50-59 yr, 60-69 yr, and 70-79 yr, respectively, had a PSA test. During 2010 and 2011, 25%, 40%, and 46% of men aged 50-59 yr, 60-69 yr, and 70-79 yr, respectively, had a PSA test. The prevalence of PSA testing increased from 2003 to 2011. The probability of retesting was PSA and age dependent, with a 26-mo cumulative incidence of 0.337 (95% confidence interval, 0.333-0.341) if the first PSA value was <1 ng/ml. The main limitations were (1) that PSA data prior to 2003 were not available and (2) that the study cohort was restricted to men who were alive in 2011.

Conclusions: Although screening for PCa is not recommended in Sweden, PSA testing in Stockholm County was high across ages ranging from 40 to 89 yr and increased during the period 2003-2011. The probability of PSA retesting was high, regardless of the original PSA level. These results contrast with current clinical recommendations and raise calls for a change, either through structured PCa testing or more detailed guidelines on PSA testing.