OBJECTIVE - Despite the controversies on its use, Prostatic Specific Antigen (PSA) screening is widely applied in clinical practice, and the variability these different recommendations could produce in daily clinical practice is not profoundly assessed. The objective was to compare the inter-practice and inter-regional variability in total and free PSA (tPSA and fPSA) requests by General Practitioners (GPs).
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METHODS - 76 laboratories covering a population of 17,679,195 inhabitants filled out the number of tPSA and fPSA requested by GPs during the year 2012. Test requests per 1,000 inhabitants and fPSA/tPSA request ratio were calculated. These variables were compared for the different hospitals according to their setting (urban, urban-rural or rural, location), and type of management (public/private). The tPSA requests necessary to comply with the recent guidelines from the European Association of Urology were calculated according to Spanish demographic characteristics in two possible scenarios depending on tPSA request: 2-4 years and 8 years interval.
RESULTS - tPSA/1,000 inhabitants ranged from 8.2 to 92.7. It was significantly higher in rural areas and varied significantly among the different geographical areas. fPSA/1,000 inhabitants was higher in hospitals with private management. A total of 1,755,712 additional tPSA tests would have been necessary to follow guidelines in the first scenario and 112,129 in the second.
CONCLUSIONS - National and regional policies are necessary to optimize the use of tPSA to detect an early prostate cancer.
Arch Esp Urol. 2015 Jul;68(6):554-561.
Salinas M1, López-Garrigós M2, Flores E2, Uris J3, Leiva-Salinas C4.
1 Laboratorio Clínico. Hospital Universitario de San Juan. San Juan de Alicante. España. Departamento de Bioquímica y Biología Molecular. Universidad Miguel Hernández. Elche. España.
2 Laboratorio Clínico. Hospital Universitario de San Juan. San Juan de Alicante. España.
3 Departamento de Salud Pública. Universidad de Alicante. Alicante. España.
4 Department of Radiology. University of Virginia. Charlottesville. USA.