Background: The prostate-specific antigen (PSA) test and its interpretation plays a crucial role in the detection of early localized prostate cancer. However, inaccuracy of the test, inability to predict the aggressiveness of the disease and the lack of evidence about the comparative effectiveness of treatments have led to major dilemmas in considering whether to employ the PSA test and which cut-off points to use in interpreting its results. The aim of this study was to evaluate current urological practice in the UK regarding the use of PSA testing. Methods: A postal questionnaire survey of all consultant urologist members of the British Association of Urological Surgeons was conducted. Statistical analysis included proportional odds regression models to examine factors associated with urologists' preferences for different definitions of ‘normal’ PSA cut-off levels. Results: The survey response rate was 60%. The majority of consultant urologists applied the PSA test routinely. There was a high level of agreement amongst UK urologists on normal PSA cut-off points (<4.0 ng/ml) for asymptomatic men under 60 years of age. There was very wide variation in the definition of normal PSA cut-offs for older (≥60 years) asymptomatic men. A preference for lower cut-off points, leading to investigation with ultrasound and biopsy, was significantly associated with larger urology department size, the presence of a prostate cancer subspecialist in the department and relatively short length of specialization in urology. Conclusions: Prostate cancer screening and early detection practices and reported incidence rates of the disease are likely to be influenced by variation in urologists' interpretations of PSA. Despite increasing evidence in favour of lower PSA cut-off levels, particularly for younger men (<60 years), urologists in the UK are divided over their interpretation. Men, particularly over age 60 years, have varying chances of further investigation following PSA testing. Any trial of prostate cancer screening or treatment should take this potential variation into account. Standard protocols for PSA interpretation should be implemented.
背景:前列腺特异性抗原(P
SA)检测及其解读在早期局限性前列腺癌的检测中起着关键作用。然而,测试的不准确性、无法预测疾病的攻击性以及缺乏治疗比较有效性的证据,导致在考虑是否使用P
SA测试及其结果解释中应采用哪些临界值时,出现了重大的困境。本研究的目的是评估英国当前泌尿科医生在使用P
SA检测方面的实践。方法:对所有英国泌尿外科医师协会的顾问泌尿科医生进行了邮寄问卷调查。统计分析采用了比例赔率回归模型,以检查与泌尿科医生对不同“正常”P
SA临界值定义的偏好相关的因素。结果:调查的回应率为60%。大多数顾问泌尿科医生常规使用P
SA测试。对于60岁以下无症状男性,英国泌尿科医生对正常P
SA临界值(<4.0 ng/ml)达成了较高一致性。而对于60岁及以上的无症状男性,正常PSA临界值的定义则差异很大。偏好较低临界值(导致进行超声检查和活检)与泌尿科部门规模较大、部门内存在前列腺癌专科医生以及泌尿专科资历相对较短显著相关。结论:前列腺癌筛查和早期检测实践以及该疾病的报告发病率可能受到泌尿科医生对PSA的解读差异的影响。尽管有越来越多的证据支持特别是针对年轻男性(<60岁)采用较低PSA临界值,英国的泌尿科医生在解读上存在分歧。尤其是60岁以上的男性在PSA检测后进一步检查的机会各不相同。任何前列腺癌筛查或治疗的试验应考虑这一潜在差异。应实施P
SA解读的标准协议。