Population-based study of prostate-specific antigen testing and prostate cancer detection in clinical practice in Northern Sweden

Objective: The pattern of prostate-specific antigen (PSA) testing in clinical practice is largely unknown; it may be used either in asymptomatic men or in the work-up of men with urinary or other symptoms. The aim of this study was to investigate the pattern of PSA testing in clinical practice for men diagnosed with stage T1c prostate cancer in a region with no formal screening programme. Material and Methods: Using the Primary Prostate Cancer Register for Northern Sweden, all cases of stage T1c prostate cancer diagnosed between 1992 and 1999 in the city of Umea were identified. The cause of PSA testing was assessed by examining the medical records. Men were categorized as asymptomatic, having lower urinary tract symptoms (LUTS) or having symptoms other than LUTS. Prospective registration of the cause of PSA testing in the entire region of Northern Sweden started in 2000. Results: We found that in Umea only 32/213 (15%) cases diagnosed with T1c prostate cancer were asymptomatic at the time of PSA testing, 55% of men had a PSA test as part of a work-up for LUTS and 30% had other symptoms. In 2000, 126 cases of stage T1c prostate cancer were diagnosed in the entire region and 20/126 (16%) of these men were asymptomatic. Conclusions: PSA testing was mostly used as a tool in the work-up of symptomatic patients in Umea and also in the region of Northern Sweden. Further studies in other populations are needed.