Objectives: to assess the frequency of total prostate-specific antigen (PSA) testing in the absence of clinical conditions in the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milan), prior to the launch of the Lombardy regional prostate cancer screening programme.
Design: the study included all men aged 30-84 years residing in the ATS Milan area who underwent at least one PSA test during the years 2018-2019 and 2021-2023. The absence of prostate-related clinical conditions was verified using local health records and the cancer registry of the ATS Milan.
Setting and participants: the study used data from administrative and healthcare databases of ATS Milan. Among the 466,616 citizens with at least one PSA tests recorded during the study period, 414,731 had the test presumably conducted for screening purposes.
Main outcome measures: at least one PSA test in the period.
Results: screening tests accounted for approximately 80% of total PSA tests. On average, 35.6% of male residents underwent at least one preventive PSA test, with low uptake among those under 50, 48.9% in those aged 50-69 years, 60.8% among men in their seventies, and 51.8% in the 80-84 age group. The mean number of PSA test per individual over the study period was 2.3. Testing decreased in 2021-2022, but increased again in 2023. A significant and increasing proportion of individuals undergoing PSA testing had three or more comorbidities. Among the 414,731 initial tests, 47.3% had PSA values <1 ng/mL, 35.4% between 1 and 3, 11.0% between 3 and 6 and 6.3% >=6.
Conclusions: the high frequency of testing among the elderly, the frequent repeat testing, and the growing involvement of individuals with multiple comorbidities highlight the need to transition to an organized screening programme capable of balancing benefits and risks.
Keywords: PSA; Population; Prostate cancer; Screening.