Background The incidence of prostate cancer has increased over the last 20 years, largely because of increased detection through prostate-specific antigen (PSA) testing. However, PSA testing as a screening tool for prostate cancer remains controversial and is not currently recommended, despite its widespread use in primary care. Currently, there is limited information regarding the characteristics of UK men who have had a PSA test. Our aim was to explore the associations between a wide range of characteristics and PSA testing in a large cohort of UK-based men, with a particular focus on risk factors or suspected risk factors for prostate cancer.
Methods The sample featured 212,039 men free from prevalent prostate cancer, benign prostatic hyperplasia or prostatitis who participated in UK Biobank, a large population-based cohort study. Participants aged 40–69 years attended one of 22 assessment centres in England, Scotland or Wales between 2006–2010. The assessment comprised electronic signed consent, a touch-screen questionnaire, a brief computer-assisted interview, physical measures, and collection of blood, urine and saliva. Multivariable logistic regression models were used to investigate the association of a range of sociodemographic, lifestyle and health-related factors with PSA testing.
Results A total of 62,022 (29%) men had a PSA test, with older men more likely to have undergone testing (4.6% in <45 year olds vs. 47.4% in ≥65 year olds). Furthermore, testing was higher in those who were of black compared to white ethnic origin (odds ratio [OR] = 1.29, 95% confidence interval [CI]: 1.17–1.42), those with higher compared to lower education (OR = 1.27, 95% CI 1.24–1.31), and those with private healthcare (OR = 1.78, 95% CI 1.71–1.85). Additionally, men who had a family history of prostate cancer, lived with a wife or partner, or had been diagnosed with (non-prostate) cancer or hypertension were more likely to have undergone PSA testing. Conversely, men who lived in more socioeconomically deprived areas, were of Asian ethnic origin, were current smokers, had a lower alcohol intake, had a higher BMI or who had been diagnosed with diabetes, heart disease or stroke were less likely to have had a PSA test.
Conclusion This is the first large-scale population-based study to show the associations between a wide range of lifestyle and health characteristics and the likelihood of having had a PSA test in the UK. Several previously identified risk factors for prostate cancer displayed similar associations with PSA testing, suggesting that the associations with prostate cancer may partly be due to detection bias.
- Prostate-specific antigen testing
- prostate cancer
- UK Biobank
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