Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines

Background Prostate specific antigen (PSA) testing is associated with increased prostate cancer (PCa) incidence. Ireland has no national guidelines on PCa screening and had the highest PCa incidence in Europe, 2006. Aims To investigate trends in PSA testing in Ireland. Methods Data on PSA tests, 1994-2005, was collated. Results Age-standardised rates of PSA testing increased 39 and 25% annually in men <50 and >= 50 years, respectively. Most tests were performed in men 50-69 years; 26 and 22% were performed in men <50 and >= 70 years, respectively. Baseline PSA tests peaked in 2004, at 16% of men. 83% of baseline tests were <4.0 ng/ml. Repeat testing increased with age and PSA level (P < 0.001); men <50 years and with levels < 4.0 ng/ml had >1 tests in <21 months. PCa incidence increased 9% annually, 1994-2005. Conclusions Uptake of PSA testing was rapid: increased use was simultaneous with increased PCa incidence. National guidelines are needed to manage this important public health issue.