JMIR Publications

ABSTRACT

Background:

The status of prostate-specific antigen (PSA) screening is unclear in China. Evidence regarding the optimal frequency and interval of serial screening for prostate cancer (PCa) is disputable.

Objective:

To depict the status of PSA screening and to explore the optimal screening frequency for PCa in China.

Methods:

A thirteen-year prospective cohort study was conducted from the Chinese Electronic Health Records Research in Yinzhou (CHERRY) dataset, including a total of 420,941 male participants aged ≥45 years. Diagnosis of PCa, cancer-specific death, and all-cause death were obtained from the electronic health records and vital statistic system. Hazard ratios (HRs) were estimated using Cox regression analysis.

Results:

The cumulative rate of ever PSA testing was 17.9% with an upward secular trend in the past decade in China. People receiving ≥3 times of serial screening had 67% higher risks of PCa detection (HR: 1.67, 95% confidence interval [CI]: 1.48-1.88), but 64% lower risks of PCa-specific mortality (HR: 0.36, 95%CI: 0.18-0.70) and 28% lower risks of overall mortality (HR: 0.72, 95%CI: 0.67-0.77). People following a serial screening strategy with at least once per four-year had 25% higher risks of PCa detection (HR: 1.25, 95%CI: 1.13-1.36), but 70% (HR: 0.30, 95%CI: 0.16-0.57) and 23% (HR: 0.77, 95%CI: 0.73-0.82) lower risks of PCa-specific and all-cause mortality.

Conclusions:

This study reveals a low coverage of PSA screening in China and indicates the benefits of an extended interval screening strategy for PCa among the general population.