• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of cmajCMAJ Information for AuthorsCMAJ Home Page
CMAJ. Jan 12, 1999; 160(1): 70–75.
PMCID: PMC1229953

Prostate-specific antigen testing in Ontario: reasons for testing patients without diagnosed prostate cancer

Abstract

BACKGROUND: The use of the prostate-specific antigen (PSA) test has been increasing rapidly in Canada since its introduction in 1988. The reasons for using the PSA test in patients without known prostate cancer are unclear. This paper reports on the first study in Canada to use physician records to assess the use of PSA testing. METHODS: A questionnaire was mailed to physicians attending 475 patients without diagnosed prostate cancer. The patients were randomly selected from 2 laboratory databases of PSA test records in the greater Toronto area during 1995. The physicians were asked to consult their patient records to avoid recall bias. Information obtained included physician's specialty, patient's age at time of PSA test and reason(s) for the test. RESULTS: There were 264 responses (56%), of which 240 (91%) were usable. Of these 240, 63% (95% confidence interval [Cl] 58%-70%) indicated that the test was conducted to screen for prostate cancer, 40% (95% Cl 34%-47%) said it was to investigate urinary symptoms, and 33% (95% Cl 27%-40%) responded that it was a follow-up to a medical procedure or drug therapy. More than one reason was permitted. Of 151 responses indicating screening as one reason for testing, 64% (95% Cl 56%-72%) stated that it was initiated by the patient, and 73% (95% Cl 65%-80%) stated that it was part of a routine examination. For 19%, both investigation of symptoms and screening asymptomatic patients were given as reasons for testing, and for another 19% both follow-up of a medical procedure and screening were given as reasons. Screening was recorded as a reason for testing far more commonly for patients seen by family physicians and general practitioners than for patients seen by urologists (67% v. 29%, p < 0.001). In contrast, the use of PSA testing to diagnose urinary symptoms was more common for patients seen by urologists than for those seen by family physicians and general practitioners (52% v. 37%, p = 0.044). No significant difference was found between physician groups in the use of PSA testing as a follow-up of a medical procedure (42% for urologists and 31% for family physicians and general practitioners). About 24% of the PSA test records were for patients younger than 50 and older than 70 years. PSA testing initiated by patients was more common in the practices of family physicians and general practitioners than in the practices of urologists (44% v. 13%, p < 0.001). INTERPRETATION: Screening for prostate cancer was the most common reason for PSA testing in our study group; it occurred most commonly in the family and general practice setting and was usually initiated by the patient. Differences in reasons for testing were identified by practice specialty. Although PSA screening for prostate cancer is sometimes recommended for men between 50 and 70 years of age, it is being conducted in men outside this age group.

Full Text

The Full Text of this article is available as a PDF (158K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Epstein JI, Pizov G, Walsh PC. Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer. 1993 Jun 1;71(11):3582–3593. [PubMed]
  • Lu-Yao GL, McLerran D, Wasson J, Wennberg JE. An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2633–2636. [PubMed]
  • Voges GE, McNeal JE, Redwine EA, Freiha FS, Stamey TA. Morphologic analysis of surgical margins with positive findings in prostatectomy for adenocarcinoma of the prostate. Cancer. 1992 Jan 15;69(2):520–526. [PubMed]
  • Bowersox J. Experts debate PSA screening for prostate cancer. J Natl Cancer Inst. 1992 Dec 16;84(24):1856–1857. [PubMed]
  • Mettlin C, Jones G, Averette H, Gusberg SB, Murphy GP. Defining and updating the American Cancer Society guidelines for the cancer-related checkup: prostate and endometrial cancers. CA Cancer J Clin. 1993 Jan-Feb;43(1):42–46. [PubMed]
  • Woolf SH. Screening for prostate cancer with prostate-specific antigen. An examination of the evidence. N Engl J Med. 1995 Nov 23;333(21):1401–1405. [PubMed]
  • Kramer BS, Brown ML, Prorok PC, Potosky AL, Gohagan JK. Prostate cancer screening: what we know and what we need to know. Ann Intern Med. 1993 Nov 1;119(9):914–923. [PubMed]
  • Barry MJ, Fleming C, Coley CM, Wasson JH, Fahs MC, Oesterling JE. Should Medicare provide reimbursement for prostate-specific antigen testing for early detection of prostate cancer? Part IV: Estimating the risks and benefits of an early detection program. Urology. 1995 Oct;46(4):445–461. [PubMed]
  • Bunting PS, Miyazaki JH, Goel V. Laboratory survey of prostate specific antigen testing in Ontario. Clin Biochem. 1998 Feb;31(1):47–49. [PubMed]
  • Mercer SL, Goel V, Levy IG, Ashbury FD, Iverson DC, Iscoe NA. Prostate cancer screening in the midst of controversy: Canadian men's knowledge, beliefs, utilization, and future intentions. Can J Public Health. 1997 Sep-Oct;88(5):327–332. [PubMed]
  • Barry MJ, Fowler FJ, Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992 Nov;148(5):1549–1564. [PubMed]
  • Hoffman RM, Papenfuss MR, Buller DB, Moon TE. Attitudes and practices of primary care physicians for prostate cancer screening. Am J Prev Med. 1996 Jul-Aug;12(4):277–281. [PubMed]
  • Plawker MW, Fleisher JM, Nitti VW, Macchia RJ. Primary care practitioners: an analysis of their perceptions of voiding dysfunction and prostate cancer. J Urol. 1996 Feb;155(2):601–604. [PubMed]
  • Hansen MV, Grönberg A. Attitudes of European urologists to early prostatic carcinoma, II. Attitude to therapy and to screening examinations. Eur Urol. 1995;28(3):196–201. [PubMed]
  • Plawker MW, Fleisher JM, Vapnek EM, Macchia RJ. Current trends in prostate cancer diagnosis and staging among United States urologists. J Urol. 1997 Nov;158(5):1853–1858. [PubMed]

Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...