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

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.