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Uptake of prostate-specific antigen testing for early prostate cancer detection in Sweden
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
2011 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 129, no 8, 1881-1888 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to estimate uptake of PSA testing in an entire country, including time trends and geographical differences. Data from the Swedish Cancer Register on prostate cancer incidence between 1980 and 2007 and published data from the Gothenburg branch of the European Randomized Study of Screening for Prostate Cancer (ERSPC), a population-based PSA screening study, were used in a multiplicative model of changes in incidence of prostate cancer as a proxy for uptake of PSA testing in all 24 Swedish counties. The estimated PSA testing in any one year, irrespective of previous years' exposure, reached a peak of 12% of all men in 2004 and decreased thereafter to 6% in 2007 and varied between 5% and 20% between counties. Under the assumption that men who underwent PSA testing were previously unexposed to PSA testing, the cumulated uptake of PSA testing in men aged 55-69 years in Sweden increased from zero in 1997 to 56% in 2007. This study shows that it is possible to estimate uptake of PSA testing in the population from the prostate cancer incidence pattern. There were large geographical variations in uptake of PSA testing despite a uniform health care system in Sweden and there was a substantial increase in the uptake of PSA testing during the study period, despite that there were no national recommendations for PSA-based prostate cancer screening.

Place, publisher, year, edition, pages
Geneve: International union against cancer , 2011. Vol. 129, no 8, 1881-1888 p.
Keyword [en]
early detection, prostate cancer, prostate-specific antigen
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-40917DOI: 10.1002/ijc.25846PubMedID: 21154740OAI: oai:DiVA.org:umu-40917DiVA: diva2:403621
Available from: 2011-03-14 Created: 2011-03-14 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Early diagnosis and treatment of prostate cancer: observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project
Open this publication in new window or tab >>Early diagnosis and treatment of prostate cancer: observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Tidig diagnostik och behandling av prostatacancer  : observationsstudier i Nationella Prostatacancerregistret och Västerbottens interventionsprojekt
Abstract [en]

Prostate-specific antigen (PSA) testing has caused a steep increase in the incidence of prostate cancer, especially the incidence of localised low risk disease. In order to decrease the overdiagnosis accompanied by PSA testing, analysis of inherited genetic variants have been suggested as potential tools for clinical assessment of disease risk. With the aim of minimizing overtreatment and postpone side-effects of curative treatment for low risk prostate cancer, active surveillance, a treatment strategy with initial surveillance and deferred radical prostatectomy at the time of progression has evolved. 

The aim of this thesis was to study the validity of PSA (paper I) and inherited genetic variants (paper II) for early diagnosis of prostate cancer, to assess the extent of PSA testing in Sweden (paper III), and to study the safety of deferred radical prostatectomy in localised low to intermediate risk prostate cancer (paper IV).

The study designs were i) case-control studies nested within the Västerbotten intervention project (paper I and II), ii) observational study in the Cancer Register of Sweden (paper III), and iii) observational study in the NPCR Follow-up study (paper IV).

PSA had a high validity in predicting a prostate cancer diagnosis with an area under the receiver operating characteristics (ROC) curve of 0.86 (95% CI, 0.84 to 0.88). A combined test, including PSA, the ratio of free to total PSA, and 33 single nucleotide polymorphisms (SNPs) in a genetic risk score, increased the area under curve to 0.87 (95% CI, 0.85 to 0.89). The estimated uptake of PSA testing among men aged 55 to 69 years increased from zero to 56% between 1997 and 2007 and there were large variations in the uptake of PSA testing between counties in Sweden. After a median follow-up time of eight years there was no significant difference in presence of any one or more adverse pathology features or prostate cancer specific mortality after primary compared to deferred radical prostatectomy in localised low to intermediate risk prostate cancer.

Results from these studies indicate that PSA and the hitherto identified SNPs are not suitable biomarkers in single-test prostate cancer screening. It is possible to estimate the uptake of PSA testing on a population level. Initial surveillance and deferred radical prostatectomy represent a feasible treatment strategy in localised low to intermediate risk prostate cancer.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 58 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1397
Keyword
Prostate cancer, prostate-specific antigen, single nucleotide polymorphism
National Category
Urology and Nephrology
Research subject
Urology
Identifiers
urn:nbn:se:umu:diva-42843 (URN)978-91-7459-134-7 (ISBN)
Public defence
2011-05-13, Sal E04, Byggnad 6E, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-21 Created: 2011-04-14 Last updated: 2011-04-21Bibliographically approved

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Jonsson, HåkanHolmström, BennyStattin, Pär

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