Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.

<h4>Introduction</h4>Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence...

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Autores principales:	Stefan Zechmann, Stefania Di Gangi, Vladimir Kaplan, Rahel Meier, Thomas Rosemann, Fabio Valeri, Oliver Senn, FIRE Study Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2019
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/623fbc0e36724331baa01bc37ade20c7
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spelling	oai:doaj.org-article:623fbc0e36724331baa01bc37ade20c72021-12-02T20:15:52ZTime trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.1932-620310.1371/journal.pone.0217879https://doaj.org/article/623fbc0e36724331baa01bc37ade20c72019-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0217879https://doaj.org/toc/1932-6203<h4>Introduction</h4>Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners.<h4>Methods</h4>We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014-mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient's age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed.<h4>Results</h4>36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59-1.90); Period 3: incidence rate-ratio 0.61 (0.56-0.67). A higher number of chronic conditions and a patient age between 60-69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value.<h4>Conclusion</h4>Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.Stefan ZechmannStefania Di GangiVladimir KaplanRahel MeierThomas RosemannFabio ValeriOliver SennFIRE Study GroupPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 14, Iss 6, p e0217879 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stefan Zechmann Stefania Di Gangi Vladimir Kaplan Rahel Meier Thomas Rosemann Fabio Valeri Oliver Senn FIRE Study Group Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
description	<h4>Introduction</h4>Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners.<h4>Methods</h4>We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014-mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient's age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed.<h4>Results</h4>36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59-1.90); Period 3: incidence rate-ratio 0.61 (0.56-0.67). A higher number of chronic conditions and a patient age between 60-69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value.<h4>Conclusion</h4>Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
format	article
author	Stefan Zechmann Stefania Di Gangi Vladimir Kaplan Rahel Meier Thomas Rosemann Fabio Valeri Oliver Senn FIRE Study Group
author_facet	Stefan Zechmann Stefania Di Gangi Vladimir Kaplan Rahel Meier Thomas Rosemann Fabio Valeri Oliver Senn FIRE Study Group
author_sort	Stefan Zechmann
title	Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
title_short	Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
title_full	Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
title_fullStr	Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
title_full_unstemmed	Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.
title_sort	time trends in prostate cancer screening in swiss primary care (2010 to 2017) - a retrospective study.
publisher	Public Library of Science (PLoS)
publishDate	2019
url	https://doaj.org/article/623fbc0e36724331baa01bc37ade20c7
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Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study.

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