CapsulesLaboratory Survey of Prostate Specific Antigen Testing in Ontario
Introduction
Prostate cancer is now the leading cancer in men, and the second most common cause of death from cancer in men [1]. This increase in incidence over a period of years is partly the result of incidental detection following use of transurethral resection of the prostate (TURP) as a treatment for benign prostatic hypertrophy (BPH) 2, 3. It is also related to increased use of the prostate-specific antigen (PSA) test in diagnosis and screening for prostate cancer 4, 5, 6.
There is little information on PSA use in Canada. A 1995 telephone survey indicated that about 20% of men over 50 years of age in Canada had their PSA measured [7], suggesting that screening for prostate cancer with PSA is well in place. Studies reporting on PSA test workload have been carried out elsewhere in Canada, including Saskatchewan [8]and Quebec [9].
There has been no formal study of PSA testing in Ontario. This is at least partly because of the difficulty accessing data about laboratory tests such as PSA that are not insured and for which there is no central record of work done. To obtain a count of PSA patient tests, the laboratories performing the tests have to be contacted directly.
In Ontario, private laboratories usually perform testing on patients who visit physicians in their private practices. The public sector comprises mostly hospital laboratories, which perform tests on patients admitted to the hospital, or visiting physicians in their outpatient clinics. In the past year or two these two sectors have started to blend, making this strict separation of patient work less reliable, though in general it still applies. Private laboratories are not licensed to perform PSA; therefore, they send the specimens to hospital laboratories in Ontario for measurement. Alternatively, some send them to laboratories outside the province. Reimbursement comes directly from the patient, because the test is not insured; patients currently pay $15 to $30 per test, depending on the laboratory. Hospital laboratories in Ontario can perform tests without a licence for a period of time, but normally request that new tests be added to their licence each year. The cost of these tests comes out of the hospital global budget.
There is almost no published data about PSA testing in Ontario. A minimum estimate for 1995 was 165,000 PSA tests, performed in 44 laboratories in the Province [10]. Apart from this data, we do not know the extent to which PSA is used either in hospital or private laboratory settings. Learning the extent of PSA utilization in Ontario is important to establish appropriate guidelines and policy for the use of the test. It is also important to estimate the burden of PSA testing on the health care system.
This article reports on a study carried out to document the patient PSA workload in Ontario. A secondary purpose of the study was to assess the feasibility of obtaining patient-specific data from laboratories to conduct longitudinal follow-up studies. The study was approved by the Research Ethics Board of Sunnybrook Health Science Centre.
Section snippets
Methods
A questionnaire was sent to all laboratories in Ontario that carry out clinical testing. A major issue relating to the administration of this questionnaire was confidentiality of PSA test workload, which some laboratories consider proprietary information. It was decided to obtain this information through an arms-length body, the Laboratory Proficiency Testing Program (LPTP) of the Ontario Medical Association. The LPTP was chosen because all laboratories are familiar with its methods of
Results
The questionnaire was sent to 292 laboratories in Ontario, and replies were received from 272, of which 45 indicated that they carry out PSA testing “on site.” This is in accordance with the 45 laboratories that received LPTP testing samples during routine surveys for PSA at that time. Since many institutions have several laboratories, it is probable that most of the apparent nonresponders had in fact submitted replies.
We were unable to separate the amount of work attributable to private and
Discussion
The extent to which we were able to obtain information from all laboratories involved in PSA testing in Ontario was most gratifying. The amount of PSA testing occurring in Ontario far exceeded our expectations, based on the 1995 snapshot [10]. The shape of the curve in Fig. 1 suggests that testing will continue to increase, though there may be a hint that the rate of increase is levelling off. This curve is consistent with that expected to be associated with the introduction of a popular new
Acknowledgements
The authors gratefully acknowledge the participation of the laboratory staff who completed the questionnaires. We also acknowledge the support of the staff of LPTP. Dr. V. Goel is supported in part by a Health Scholar Award for the National Health Research and Development Program.
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