Low-risk men can wait up to 4 years between PSA tests

  • Palsdottir T & al.
  • BMJ Open
  • 30 Mar 2019

  • International Clinical Digest
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Takeaway

  • Men with PSA ≤1 ng/mL can wait 3-4 years before another PSA test.

Why this matters

  • Recommended screening intervals vary; PSA tests have high false-positive rates that can result in overtreatment.

Study design

  • Researchers studied men with ≥2 PSA tests conducted between 2003 and 2015 in Stockholm, Sweden (n=174,636; age range, 50-74 years).
  • They calculated the risk ratio (RR) of Gleason score (GS) ≥7 and GS 6 vs benign outcomes at prostate biopsy and 12-year cumulative probability of experiencing a false-positive biopsy by testing interval, age, PSA level, and first-degree family history.
  • Funding: Swedish Cancer Society; Swedish Research Council; Swedish Research Council for Health Working Life and Welfare; Swedish e-Science Research Center; Nordic Information for Action eScience Center.

Key results

  • Regardless of testing interval, men with PSA ≤1 ng/mL had low risk for GS ≥7 prostate cancer (PCa) diagnosis at the next test.
  • In contrast, men with PSA >1 ng/mL had increased risk for GS ≥7 PCa with testing intervals >1 year (RR range, 1.4-3.2, depending on PSA and testing interval).
  • The effects of shorter or longer testing intervals appear similar regardless of patient age or family history.

Limitations

  • The study was observational with potential for confounding.