Retrospective analysis to describe trends in first-ever prostate-specific antigen (PSA) testing for primary healthcare facilities in the Gauteng Province, South Africa, between 2006 and 2016

Abstract

Objectives: The objective of our study was to use laboratory data to describe prostate-specific antigen (PSA) testing trends for primary healthcare (PHC) services from a single province. PHC is a basic package of services offered to local communities, serving as the first point of contact within the health system. These services are offered at clinics and community health centres (CHC), the latter providing additional maternity, accident and emergency services.

Design: The retrospective descriptive study design was used.

Methods: We analysed national laboratory data between 2006 and 2016 for men ≥30 years in the Gauteng Province. We used the probabilistic matching algorithm to create first-ever PSA cohort. We used the hot-deck imputation to assign missing race group values and the district health information system facility descriptors to identify PHC testing. We reported patient numbers by calendar year, age category and race group as well as descriptive statistics. We used multivariable logistic regression to assess any association for race group and age with a PSA ≥4 µg/L.

Results: Between 2006 and 2016, numbers of men tested increased from 1782 to 67 025, respectively, with 186 984/239 506 (78.1%) tests were from clinics. The majority of testing was for men in the 50-59 age category (31.5%) and Black Africans (86.4%). We reported a median of 0.9 µg/L that increased with age. A PSA ≥4 µg/L was reported for 11.7% of men, increasing to 35.5% for the ≥70 age category. The logistic regression reported that the adjusted odds of having a PSA ≥4 µg/L was significantly lower for Indian/Asians, multiracials and whites than for Black Africans (p value<0.0001).

Conclusions: Our study has shown a marked increase in PSA testing from clinics and CHC suggestive of screening for prostate cancer. The approaches reported in this study can be extended for national data.

Keywords: chemical pathology; primary care; prostate disease.

Figure 1

Flowchart depicting all the data steps to generate the data used to create the first-ever PSA cohort for primary health services between 2006 and 2016 in the Gauteng Province, South Africa. PSA, prostate-specific antigen.

Figure 2

Percentage year on year change reported as a bar chart for patients with a first-ever total prostate-specific antigen (PSA) test at primary healthcare services in the Gauteng Province, South Africa. The annual test volumes were reported as a line chart.

Figure 3

Annual PSA test volumes by unit type for primary healthcare services. The annual PSA volumes are reported for clinics (green bars) and community health centres (blue bars) between 2006 and 2016 in the Gauteng Province, South Africa.

Figure 4

Line chart reporting the number of patients with a first-ever total prostate-specific antigen (PSA) test by year and age category (A) and race group (B) for primary healthcare facilities between 2006 and 2016 in the Gauteng Province, South Africa.