Background
Prostate-specific antigen (PSA) testing in asymptomatic men for prostate cancer is associated with benefits and harms, including overdiagnosis and overtreatment. During the study period, Australian guidelines recommended caution regarding PSA testing in men aged ≥70 years. However, PSA testing remained common, and little is known about the characteristics of older men who undergo testing. This study examined patterns of PSA testing and factors associated with its use among men aged ≥70 years.
Methods
Participants from the Sax Institute's 45 and Up Study (NSW, Australia) were recruited between 2006 and 2009. Self-reported baseline data and linked administrative health records from the Centre for Health Record Linkage (CHeReL) and Services Australia were used to identify cancer registrations and reimbursements for PSA testing between 1/1/2016 and 31/12/2019, respectively. A total of 41,099 men, aged ≥70 years on 1/2016 and with no prior prostate cancer diagnosis record were included in this analysis. Logistic regression analyses identified factors associated with PSA testing during the study period.
Results
During the study period, 44.6% of men aged ≥70 years underwent PSA testing, and 3.3% were diagnosed with prostate cancer. Men with private health insurance were more likely to be tested (OR 1.27, 95% CI 1.21-1.32). Compared with men aged 70-74 years, those aged 75-79 years had lower odds of PSA testing (OR 0.75, 95% CI 0.71-0.79). Unmarried or unpartnered men (OR 0.81, 95% CI 0.76-0.85) and those with severe comorbidity index of ≥4 (OR 0.48, 95% CI 0.42-0.54) were also less likely to undergo PSA testing.
Conclusions
PSA testing was common among men aged ≥70 years in the 45 and Up Study. Men who underwent PSA testing generally represented a healthier subgroup than those who did not. Further research is needed to better support informed and shared decision-making regarding PSA testing in older men.