Breidablik Hans Johan, Meland Eivind, Aakre Kristin Moberg, Førde Olav Helge
Tidsskr Nor Laegeforen. 2013 Sep 3;133(16):1711-6. doi: 10.4045/tidsskr.13.0023.
Growing attention is being paid to PSA testing and the risk of overdiagnosis of prostate cancer. This paper investigates how the number of PSA tests has developed over time in Norwegian counties, and relates this development to the incidence of cancer in the various counties and the rates of prostate cancer surgery.
Data on incidence, survival and mortality were obtained from public registers. The numbers of PSA tests carried out were acquired from Norwegian laboratories. The PSA testing rates per county and correlation with prostate cancer incidence rates and surgery rates were surveyed. Developments in Sogn og Fjordane, which has the highest incidence of prostate cancer in Norway, were examined separately. A net-based survey of primary doctors' attitudes and practice was carried out.
The number of PSA tests increased substantially in the period 1999-2011 and in 2011 corresponded to testing of 45% of the total male population aged over 40 in Norway. The number of PSA tests in 2011 correlated with the incidence by county of prostate cancer in the previous period (Pearson's r = 0.41). The correlation between the incidence of cancer and surgical procedures was 0.66. In Sogn og Fjordane, the prostate cancer incidence and survival are rising steeply, while mortality is at the same level as in Norway generally. Primary doctors often comply with their patients' wish for PSA testing and find it difficult not to refer them to specialists if values are elevated.
There is probably a correlation between the increased incidence of prostate cancer and the amount of PSA testing. Compliance with the guidelines for testing should be better and clinicians could practice more watchful waiting with regard to further treatment in cases of elevated PSA values.
前列腺特异性抗原（PSA）检测及前列腺癌过度诊断的风险日益受到关注。本文研究了挪威各郡PSA检测数量随时间的变化情况，并将这一变化与各郡癌症发病率及前列腺癌手术率相关联。
从公共登记处获取发病率、生存率和死亡率数据。PSA检测数量来自挪威各实验室。调查了各郡的PSA检测率及其与前列腺癌发病率和手术率的相关性。对挪威前列腺癌发病率最高的松恩-菲尤拉讷郡的情况进行了单独研究。开展了一项针对初级医生态度和做法的网络调查。
1999年至2011年期间，PSA检测数量大幅增加，2011年相当于对挪威40岁以上男性总人口的45%进行了检测。2011年的PSA检测数量与上一时期各郡前列腺癌发病率相关（皮尔逊相关系数r = 0.41）。癌症发病率与手术率之间的相关性为0.66。在松恩-菲尤拉讷郡，前列腺癌发病率和生存率急剧上升，而死亡率与挪威总体水平相同。初级医生通常会满足患者进行PSA检测的愿望，并且发现如果PSA值升高，很难不将患者转诊给专科医生。
前列腺癌发病率的增加可能与PSA检测量有关。应更好地遵循检测指南，临床医生对于PSA值升高的病例在进一步治疗方面可更多地采用观察等待策略。
