Factors affecting prostate cancer detection through asymptomatic prostate-specific antigen testing in primary care in England: evidence from the 2018 National Cancer Diagnosis Audit.

IF 5.2 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
British Journal of General Practice Pub Date : 2025-05-02 Print Date: 2025-05-01 DOI:10.3399/BJGP.2024.0376
Samuel Wd Merriel, Nurunnahar Akter, Nadine Zakkak, Ruth Swann, Sean McPhail, Greg Rubin, Georgios Lyratzopoulos, Gary Abel
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引用次数: 0

Abstract

Background: Prostate-specific antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision.

Aim: 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.

Design and setting: 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 (n = 9837).

Method: 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.

Results: 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.

Conclusion: 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.

影响英格兰基层医疗机构通过无症状 PSA 检测发现前列腺癌的因素:来自2018年全国癌症诊断审计的证据。
背景 前列腺特异性抗原(PSA)被用于前列腺癌的初级保健检测,既可用于症状评估,也可在知情决定后进行无症状检测。目的 估计通过无症状 PSA 检测确诊的前列腺癌病例比例,以及影响这一检测途径的患者和实践因素。设计与设置 分析2018年英国国家癌症诊断审计(NCDA)数据,并与国家癌症登记、实践层面的质量成果框架(QOF)和全科患者调查(GPPS)数据进行关联。纳入了所有2018年NCDA诊断为前列腺癌的患者(n = 9837)。方法 将有生物标志物检测记录且诊断前无症状记录的患者归类为无症状 PSA 检测出的前列腺癌患者。使用混合效应逻辑回归模型分析了患者(年龄、种族、贫困程度、合并疾病)和全科医生(地理位置、贫困程度、名单规模、紧急疑似癌症转诊率、QOF结果、GPPS结果)因素与无症状PSA检测的关系。结果 9837 例前列腺癌患者中有 1884 例(19%)是在无症状 PSA 检测后发现的,其中 982 例(52.1%)患者的年龄在 50-69 岁之间。年龄越小、非白种人、贫困程度越低、合并疾病数量越少,在进行无症状 PSA 检测后确诊的可能性就越大。不同医疗机构的无症状 PSA 检测病例几率相差 13 倍,但没有明确的 GP 医疗机构层面的解释因素。结论 在英格兰,每五名前列腺癌患者中就有一名是在基层医疗机构进行无症状 PSA 检测后确诊的,而全科医生诊所之间无症状 PSA 检测的差异很大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
British Journal of General Practice
British Journal of General Practice 医学-医学:内科
CiteScore
5.10
自引率
10.20%
发文量
681
期刊介绍: The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide. BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.
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