Enrico Caraceni1, Daniele Mazzaferro1, Luca Leone2, Matteo Tallè2, Andrea Benedetto Galosi2
  • 1 Ospedale di Civitanova Marche, U.O. Urologia (Civitanova Marche)
  • 2 Università Politecnica delle Marche, Dipartimento di Urologia (Ancona)


Nowadays the use of PSA in clinical practice is a question of matter. In particular PSA is not always tested with accuracy and according to latest reccomendations (1-2). Clinical consequences of PSA testing could be prostate biopsy and radical prostatectomy (2).
In Italy from 2010 reflex PSA is daily used in clinical practice (for PSA value between 2 ng/ml and 10 ng/ml PSA free is automatically computed).
In Marche Region PSA reflex has been used since July 2012 and, starting from late 2014, the Region has provided a reduction of PSA free cost.
Aim of the study was to determine the trend of regional employment of PSA total and free/total ratio testing; to evaluate the effect upon sanitary costs and its consequences in terms of number of prostate biopsy and radical prostatectomy.

Materials and Methods

We analyzed data coming from Marche Region about the employment of free/total PSA ratio and reflex PSA from 2010 to 2014, divided per age groups. In the same period we analyzed the number of US-guided prostate biopsies and radical prostatectomy performed.


The number of total and free PSA testing decreased of 43.5% and 35.3%, respectively, followed by a continuous increasing of reflex PSA up to 44% in the 2011-2014 period.
Even considering the more frequent use of reflex PSA, we observed a reduction of 50000 PSA testing.
On the other hand prostate biopsy showed an increasing of 300 procedures per year until 2014, while during the same period radical prostatectomy performed in Marche Region or in other Italian Region on Marche inhabitants (passive mobility) showed a decreasing of 100 procedures.


The regional trend of PSA testing has been decresing, also because of regional sanitary administration choices; nevetheless the trend could be bettered.
The lack of biopsies decreasing in the 2011-14 period could be due to more accuracy PSA testing.
The decrease of radical prostatectomy procedures could be explained with a better comprehension of prostate cancer biological behavior that leaded to less aggressive and watchful approaches; according to this, PSA testing reduction is only partially involved.


PSA testing has been largely overused especially in age groups in which it should be avoided (2-3-4-5).
Valid conclusions will be obtained by ongoing observation of the trends in years to come.


1. Opportunistic prostate-specific antigen screening in Italy: 6 years of monitoring from the italian general practice database G.G. d’Ambrosio, S. Campo, M. Cancian, S. Pecchioli and G. Mazzaglia E.Journal Cancer Prevention 2010, Vol.19 N.6; 413-416

2. EAU Guidelines 2016; Prostate cancer

3. Vedel I, Puts MTE, Monette M, Monette J, Bergman H: The decision-making process in prostate cancer screening in primary care with a prostatespecific antigen: A systematic review. J Geriatr Oncol 2011, 2011. doi:

4. Djulbegovic M, Beyth RJ, Neuberger MM, Stoffs TL, Vieweg J, Djulbegovic B, Dahm P: Screening for prostate cancer: systematic review and
meta-analysis of randomised controlled trials. BMJ 2010, 2010. doi:

5. Doctors’ perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK:
a qualitative study. Pickles K, et al. BMJ Open 2016;6:e011932. doi:10.1136/bmjopen-2016-011932