While it is known that national PSA testing rates have decreased in Australia since 2007, it is not known whether these trends are consistent by broad geographical areas, nor whether previously reported area-specific differences have remained in more recent time periods.
Population-based cohort study of Australian men (n = 2793,882) aged 50-69 who received at least one PSA test (Medicare Benefit Schedule item number 66655) during 2002-2018. Outcome measures included age-standardised participation rate, annual percentage change using JoinPoint regression and indirectly standardised participation rate ratio using multivariable Poisson regression.
During 2005-09, two thirds (68%) of Australian men aged 50-69 had at least one PSA test, reducing to about half (48%) during 2014-18. In both periods, testing rates were highest among men living in major cities, men aged 50-59 years, and among men living in the most advantaged areas. Nationally, the Australian PSA testing rate increased by 9.2% per year between 2002 and 2007, but then decreased by 5.0% per year to 2018. This pattern was generally consistent across States and Territories, and socio-economic areas, however the magnitude of the trends was less pronounced in remote and very remote areas.
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 equivocal evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer to be implemented consistently regardless of where men live.
Cancer epidemiology. 2023 Feb 23 [Epub ahead of print]
Ankur Kohar, Susanna M Cramb, Kristen Pickles, David P Smith, Peter D Baade
The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Australia., School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, Australia., Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, Australia., The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Cancer Council Queensland, Brisbane, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, Australia; Menzies Health Institute, Griffith University, Gold Coast, Australia. Electronic address: .