Spatio-temporal patterns of prostate-specific antigen testing in asymptomatic men: a population-based cohort study, Australia, 2002–2018

Abstract

Objective

Prostate-specific antigen (PSA) testing rates vary by small geographical area in Australia, yet little is known about how these variations have changed over time. This study aims to examine spatio-temporal patterns in Australia during 2002–2018.

Study design

Retrospective population-based cohort study.

Methods

We obtained Medicare Benefit Schedule data on PSA testing (n = 9,342,134) during 2002–2018 from the Commonwealth Department of Health, Australia for men aged 50–79 years. Postcodes were mapped to statistical areas level 2 (n = 2133) using a probability-based correspondence file and multiple (n = 50) iterations. Bayesian spatio-temporal models were used to generate indirectly standardized incidence ratios for each small area over time compared to the national average.

Results

The annual percentage of men aged 50–79 who received a PSA test for asymptomatic testing increased from 15·6 % up to 24·5 % in 2008, before declining to 14·8 %. Geographical patterns of PSA testing varied substantially over time, with many areas deviating from the national trend. Between 2002 and 2008, 80 % of small areas had testing rates increase, while 93 % of areas decreased from 2008 to 2018. East coast and southwest regions of Australia, primarily major cities and regional areas, exhibited the most divergent temporal trends, while many remote areas maintained consistently low testing rates.

Conclusion

The extent and patterns of geographic variation in PSA testing rates across small areas has changed over time. Understanding the reasons for this variation remains a priority, to help ensure all men at risk have equitable access to relevant decision-making process and information about PSA testing.