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Men who undertake the prostate specific antigen (PSA) screening test for prostate cancer in the summer are more likely to have a subsequent biopsy than men tested at any other time of the year.
A new study, published in European Urology (doi: 10.1016/j.eururo.2006.11.042) shows that concentrations of PSA are higher in the summer, resulting in a higher likelihood of referral for a biopsy of up to a quarter.
“We show that being screened during summer increased by 23% the likelihood of having a higher PSA than the cut-off value [for biopsy],” the authors write. “It may be prudent to confirm any isolated test result before biopsy, and even more so if this was obtained in summer.”
They add: “The present observation . . . is troubling as it suggests that rigid PSA cut-offs are ill-adapted to routine clinical practice.”
The authors say that measurement of PSA serum concentrations is central to all programmes for the early detection of prostate cancer but that the influence of season on PSA concentrations has been little investigated.
The authors looked at the relation between meteorological data and total PSA testing (which measures nanograms of PSA per millilitre of blood) as well as free PSA testing (which measures the percentage of PSA that is not bound to proteins in the blood) in 8644 men aged 55 to 70 who were taking part in the French arm of the European randomised study of screening for prostate cancer (ERSPC).
Significantly higher PSA concentrations (P= 0.001) were found in summer (total PSA 1.87±0.06 ng/ml) than in autumn (1.71±0.07 ng/ml), winter (1.42±0.06 ng/ml), or spring (1.38±0.13 ng/ml).
Their results also showed that men who were screened in summer more often gave a PSA test result of >3 ng/ml (17.1% of men), the recommended ERSPC cut-off for biopsy, than those tested in autumn, winter, or spring (14.3%) (P<0.001), resulting in a 23% increase in the likelihood of being referred for biopsies in the summer (odds ratio 1.23 (95% confidence interval 1.1 to 1.4)).