Merriel Samuel Wd, Akter Nurunnahar, Zakkak Nadine, Swann Ruth, McPhail Sean, Rubin Greg, Lyratzopoulos Georgios, Abel Gary
Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Exeter collaboration of Academic Primary Care (APEx), University of Exeter, Exeter; Department of Health Data Science, University of Liverpool, Liverpool.
Br J Gen Pract. 2025 May 2;75(754):e300-e305. doi: 10.3399/BJGP.2024.0376. Print 2025 May.
Prostate-specific antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision.
To estimate the proportion of patients with prostate cancer who were diagnosed following asymptomatic PSA testing, and the patient and practice factors influencing this route.
The 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the National Cancer Registration and Analysis Service, practice-level Quality and Outcomes Framework (QOF), and GP Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included ( = 9837).
Patients with recorded biomarker testing and no recorded symptoms before diagnosis were classified as having asymptomatic PSA-detected prostate cancer. Patient (age, ethnicity, deprivation, and comorbidities) and practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, and GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed-effects logistic regression models.
In total, 1884 out of 9837 (19.2%) patients with prostate cancer were detected following asymptomatic PSA testing, 982 (52.1%) of whom were aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower comorbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of detecting prostate cancer through asymptomatic PSA testing, without clear explanatory practice-level factors.
One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between practices.
前列腺特异性抗原（PSA）用于基层医疗中前列腺癌的检测，可用于有症状评估或在做出知情决定后的无症状检测。
估计通过无症状PSA检测确诊的前列腺癌患者比例，以及影响这一诊断途径的患者和医疗机构因素。
分析了2018年英国国家癌症诊断审计（NCDA）数据，并与国家癌症登记与分析服务、医疗机构层面的质量与结果框架（QOF）以及全科医生患者调查（GPPS）数据相链接。纳入了2018年NCDA中所有诊断为前列腺癌的患者（n = 9837）。
诊断前有生物标志物检测记录且无症状记录的患者被归类为无症状PSA检测发现的前列腺癌患者。使用混合效应逻辑回归模型分析患者因素（年龄、种族、贫困程度和合并症）和医疗机构因素（地理位置、地区贫困程度、名单规模、紧急疑似癌症转诊率、QOF结果和GPPS结果）与无症状PSA检测的相关性。
在9837例前列腺癌患者中，共有1884例（19.2%）通过无症状PSA检测确诊，其中982例（52.1%）年龄在50 - 69岁之间。年龄较小、非白人种族、贫困程度较低和合并症数量较少与无症状PSA检测后确诊的可能性增加相关。通过无症状PSA检测发现前列腺癌的几率在不同医疗机构之间存在13倍的差异，且没有明确的可解释的医疗机构层面因素。
在英国，五分之一的前列腺癌患者是在基层医疗中通过无症状PSA检测确诊的，不同医疗机构之间无症状PSA检测的差异很大。
