Factors Related to Prostate-Specific Antigen–Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years

Abstract

BackgroundInternational guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities.ObjectiveThe objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening.MethodsWe analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression.ResultsThe proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years—age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)—whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years—low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)—whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing.ConclusionsIn this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbiditie...

Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

“…We also evaluated potential variables associated with a PSA request that was potentially non-compliant with the current guideline. We speculated that some specific patient characteristics (diabetes diagnosis [ 8 , 9 ], consuming tobacco, alcohol, or other drugs [ 10 , 11 ]) could be associated with lower probability of having a potentially non-compliant PSA test due to lower testing frequency. Nevertheless, although we found no difference in PSA test compliance with the guideline in patients with diabetes diagnoses, those who were current consumers of tobacco, alcohol, and/or other drugs showed 20% lower potential non-compliance.…”

“…The intervals between testing were often shorter than recommended, and screening among younger men without risk factors was frequent [ 7 ]. In addition, a different PSA testing behaviour has been described among patients with certain characteristics, such as men with diabetes [ 8 , 9 ], patients with cancer [ 10 ], or non-smokers [ 10 , 11 ].…”

Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results

“…While lower frequency of testing has been reported among obese men, who are at greater risk of developing diabetes, 25,26 more frequent PSA testing has been reported in men with comorbid conditions, particularly cardiovascular conditions. 26,27 For diabetes specifically, some 26,28,29 but not all 24,30 studies report increased frequency of PSA testing among men with diabetes. Our findings suggest that men who are likely to develop diabetes undergo PSA testing less frequently, but once prescribed metformin and sulfonylurea undergo slightly more frequent testing compared with those not receiving medications.…”

“…While lower frequency of testing has been reported among obese men, who are at greater risk of developing diabetes, 25,26 more frequent PSA testing has been reported in men with comorbid conditions, particularly cardiovascular conditions. 26,27 For diabetes specifically, some 26,28,29 but not all 24,30 studies report increased frequency of PSA testing among men with diabetes. Our findings suggest that men who…”

Prostate- Specific Antigen (PSA) Significance in Frail and Sarcopenic Men

“…Nevertheless, it has been observed in various studies that individuals presenting with less severe concurrent medical conditions, such as angina, high cholesterol, and hypertension, exhibit a higher propensity towards undergoing prostate-specific antigen (PSA) tests. This inclination may be attributed to their increased frequency of visits to healthcare establishments [15,16].…”