What is known?
It is widely reported that the national PSA testing rates in Australia have declined since 2007. However, what remains uncertain is whether this decrease is consistent across all major geographical regions in the country, and whether previously reported variations in testing rates between different areas still persist.
What is new?
We used Medicare data involving nearly 3 million Australian men, aged 50 to 69, who had at least one PSA test between 2002 to 2018. We used different statistical methods to measure trends over time and differences between geographical areas.
Between 2005 and 2009, about 68% of men aged 50 to 69 in Australia had at least one PSA test, but this decreased to 48% during 2014 to 2018. The rates of testing (adjusted for population size) were highest in major cities, among men aged 50 to 59, and those living in more affluent areas. Nationally, the overall PSA testing rate increased by 9.2% every year from 2002 to 2007, but then it decreased by 5.0% per year until 2018. This trend was similar across different states and regions, but the trend over time was less pronounced in remote areas.
What does this mean?
The decreasing trends are consistent with a greater awareness of the current guidelines for clinical practice in Australia, which recommend a PSA test be done only with the informed consent of individual men who understand the potential benefits and risks.
However, given there remain substantial geographical disparities in prostate cancer incidence and survival in Australia, along with the uncertain evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer, and for these to be implemented consistently regardless of where men live.
Contact: Peter Baade
Reference: Kohar A, Cramb SM, Pickles K, Smith DP, Baade PD. Changes in prostate specific antigen (PSA) “screening” patterns by geographic region and socio-economic status in Australia: Analysis of Medicare data in 50-69 year old men. Cancer Epidemiology. 2023 Apr;83:102338. doi: 10.1016/j.canep.2023.102338. Epub 2023 Feb 24.