Prostate-specific antigen testing and prostate cancer-related outcomes: a Danish nationwide study

Objective: To assess the prostate-specific antigen (PSA) testing and prostate cancer-related outcomes in a national, publicly funded healthcare setting, with recommendations against testing of asymptomatic men. Subjects and Methods: All men born between 1920 and 1970, alive and residing in Denmark on 1 January 2014, were quarried in the national health registries. Age-standardised rates (ASR) per 100 000 men for men aged >50 years and cumulative incidence at 100 years by Aalen Johansen estimator with delayed entry were estimated for PSA testing, prostate histology, biopsy, prostate cancer diagnosis, and prostate cancer-specific death. Results: Among 1 371 099 eligible men, the ASR of PSA testing in 2023 was 14 659 tests per 100 000 men (95% confidence interval [CI] 14 585–14 733), and 21 828 tests per 100 000 men (95% CI 21 646–22 111) in men aged 70–79 years. Cumulative incidence at 100 years of a PSA test was 84% (95% CI 84–84%), prostate histology 20% (95% CI 20–20%), biopsy 15% (95% CI 15–15%), prostate cancer diagnosis 12% (95% CI 11–12%), and prostate cancer-specific death 5.0% (95% CI 5.0–5.1%). The median (interquartile range [IQR]) age at initial PSA test was 60 (52–67) years, 70 (64–76) years at prostate histology and biopsy, 72 (66–78) years at prostate cancer diagnosis, and 84 (78–89) years at prostate cancer-specific death. Conclusions: In Denmark PSA testing rates are high and prevalent in older ages, despite restrictive national guidelines and active training against PSA testing for general practitioners. The findings support the discussion of whether the availability of the PSA test should be reconsidered to minimise the harms associated with unnecessary testing.