Prostate-specific antigen testing and opportunistic prostate cancer screening: a cohort study in England, 1998–2017

Clift, Ashley Kieran; Coupland, Carol A.C.; Hippisley-Cox, Julia

Abstract

Background: Prostate cancer is a leading cause of cancer-related death. Interpretation of results from trials of screening with prostate-specific antigen (PSA) are complex in terms of defining optimal prostate cancer screening policy.

Aims: Assess the rates of, and factors associated with the uptake of PSA testing and opportunistic screening (PSA test in absence of symptoms) in England between 1998 and 2017. Estimate the likely rates of pre-randomisation screening and contamination (unscheduled screening in ‘control’ arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (“CAP”).

Design and Setting: Open cohort study of men aged 40-75 years at cohort entry (1998-2017) undertaken using the QResearch database.

Method: Eligible men were followed for up to 19-years. Rates of PSA testing and opportunistic PSA screening were calculated and Cox regression was used to estimate associations.

Results: The cohort comprised 2,808,477 men, of whom 631,426 had a total of 1,720,855 PSA tests. We identified that 410,751 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort: 10% at 5yrs, 23% at 10yrs, and 44% at 19yrs of follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.5%.

Conclusions: A substantial number of men in England opt-in to opportunistic prostate cancer screening despite uncertainty regarding the efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial making it difficult to interpret the results.

Citation

Clift, A. K., Coupland, C. A., & Hippisley-Cox, J. (2021). Prostate-specific antigen testing and opportunistic prostate cancer screening: a cohort study in England, 1998–2017. British Journal of General Practice, 71(703), e157-e165. https://doi.org/10.3399/bjgp20X713957

• Journal Article Type: Article
• Acceptance Date: Jul 10, 2020
• Online Publication Date: Jan 11, 2021
• Publication Date: Jan 11, 2021
• Deposit Date: Sep 3, 2020
• Publicly Available Date: Jan 12, 2022
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 71
• Issue: 703
• Pages: e157-e165
• DOI: https://doi.org/10.3399/bjgp20X713957
• Keywords: prostate cancer, screening, prostate-specific antigen, primary health care
• Public URL: https://nottingham-repository.worktribe.com/output/4880627
• Publisher URL: https://bjgp.org/content/71/703/e157