Australia has one of the highest incidence rates of prostate cancer (PC) worldwide, due in part to widespread prostate specific antigen (PSA) testing. We aimed to identify factors associated with PSA testing in Australian men without a diagnosis of prostate cancer or prior prostate disease.
Participants were men joining the 45 and Up Study in 2006-2009, aged ≥45 years at recruitment. Self-completed questionnaires were linked to cancer registrations (1994-2010), hospitalisations (2001-2014), deaths (2006-2014) and health services (2004-2014) data. We identified Medicare reimbursed PSA tests during 2012-2014. Men with a history of PC, radical prostatectomy or a “monitoring” PSA test for prostate disease were excluded. We used multivariable logistic regression to estimate adjusted odds ratios (OR) for the association between having PSA tests and factors of interest.
Of the 62,765 eligible men, 51.8% had at least one screening PSA test during 2012-2014. Factors strongly associated with having a PSA test included having 27+ general practitioner consultations during the 3 years (versus 3-9 consultations; OR=2.00;95%CI=1.90-2.11), benign prostatic hyperplasia treatment (versus none;OR=1.59(95%CI=1.49-1.70), aged 60-79 years (versus 50-59 years; OR=1.54;95%CI=1.48-1.60), higher income, and private health insurance (versus none; OR=1.41;95%CI=1.35-1.48). Family history of PC, bowel screening participation, supplement/medication use, and several other factors were associated with testing.
Over half of this cohort had a PSA test during a three-year period. PSA testing was most strongly associated with frequent consultations with general practitioners.
These findings emphasise the role of general practitioners in shared decision-making for asymptomatic men considering PSA testing.