Objectives Prostate cancer (PCa) is the second most commonly diagnosed cancer in Australia men. It is estimated that each year at least 20% of Australian men aged 45 – 74 have a prostate-specific antigen (PSA) test for the purpose of early diagnosis of PCa. However, evidence suggests there has been inappropriate utilisation of PSA testing, in terms of frequency and target population. Our aims were 1) to measure the level of variation in PSA testing in general practices (GPs) across Primary Health Networks (PHNs) in Victoria, Australia, and 2) to report on current PSA testing practices among patients aged between 50 and 69 years, according to the recommendations by the Prostate Cancer Foundation and Cancer Council of Australia.

Method This was a retrospective observational study of male patients aged 18 and over who visited the same GPs at least three times between 1st October 2016 and 30th September 2018 and had at least one PSA test result available. Data were extracted from GPs across three PHNs in Victoria. Patients with a recorded diagnosis or family history of PCa or prostatic disease were excluded.

Results This study included 56,859 patients and 80,957 PSA tests. The overall PSA testing prevalence among patients aged 50 and over was 43%. Across PHNs, the proportions of tested patients aged 50 and over were 50% (PHN A), 22% (PHN B), and 43% (PHN C). Among those aged 70 and over, around 46% had a PSA test at PHN A, 19% at PHN B, and 40% at PHN C. The frequency of PSA testing increased with age, and this pattern was similar across PHNs. Of all tested patients aged 70 and over, 44% had multiple PSA tests. Among patients aged between 50 and 69 years, a total 47,500 PSA tests were available. Of those, 57% fell within guidelines (56% at PHNs A and C vs 69% at PHN B).

Conclusions Our study showed that a large number of patients aged 70 and over had a PSA test during the analysis period, and a high proportion of those were tested multiple times. Among patients aged 50 – 69 years, a considerable number of PSA tests were requested outside recommendations.