Improving Appropriateness of Prostate-Specific Antigen Screening

We read with interest the recent article by Kerfoot et al,¹ who concluded that prostate-specific antigen (PSA) screening is commonly performed counter to evidence-based guidelines. We performed a similar analysis, retrieving results of PSA tests performed in the Department of Laboratory Medicine at the University Hospital of Verona, Verona, Italy, which serves an area with a population of 270 000 inhabitants with 750 beds and specialized care units. Similar to the study by Kerfoot et al,¹ data on PSA test use from 2002 to 2007 were obtained from the databases of our laboratory information system for 12 570 male patients, excluding patients who underwent PSA testing for nonscreening reasons, as indicated by prostate cancer–specific medications, diagnoses, and procedures. The percentage of overall inappropriate tests was almost identical to that reported by Kerfoot et al¹ (19.3% vs 19.4%; P = .98 by χ² analysis), with 18.1% in patients older than 75 years (vs 18.4%; P = .94) and 0.8% in patients younger than 40 years (vs 0.8%; P > .99). However, we also stratified the PSA test use according to the provenience of the patients, observing that the prevalence of inappropriate test requests was significantly greater in outpatients than inpatients (overall data: 32.4% vs 15.4% [P < .001]; patients older than 75 years: 29.4% vs 14.6% [P < .001]; and patients younger than 40 years: 3.0% vs 0.8% [P < .01]). These results confirm that the prevalence of requests for PSA screening counter to evidence-based guidelines might be high also in Europe, and we further highlight that this problem might be more of a concern among general practitioners than hospital physicians.