Significant reduction in prostate screening rates after revised guidelines

1. In a cross-sectional analysis of a nationally administered survey in the United States of men undergoing prostate specific antigen screening, a significant decline in screening rates of men over 50 years of age was observed since the 2012 USPSTF screening guidelines.

Evidence Rating Level: 3 (Average)

Study Rundown: Significant debate remains concerning guidelines for prostate specific antigen (PSA) screening for prostate cancer. National guidelines published by the American Urological Association recommend routine screening based on age, risk factors, and life expectancy. However, the United States Preventative Services Task Force (USPSTF) published revised guidelines in 2012 that recommended against the routine use of PSA screening and advised that clinicians should only engage in shared decision making with men who have at least 10 years of life expectancy. Primary care physicians have previously cited the USPSTF as the most influential source of recommendations; therefore, the purpose of this study was to investigate whether population PSA screening has decreased following the release of these guidelines. The authors reviewed the results of a large, cross-sectional, national survey from 2005, 2010, and 2013. At the conclusion of the study, PSA screening was found to be significantly reduced among men 50 years or older from 2009 to 2013. However, approximately one third of men aged 65 years and older with a high risk of 9-year mortality (1.4 million men) underwent screening. The results of this study support the conclusion that increased number of primary care clinicians are adhering to the USPSTF guidelines. The survey is an interview-based, self-reporting database, which may under-report prostate screening frequencies. Furthermore, no information was available on further testing such as prostate biopsies or additional imaging. Additional population trials are required to elucidate the effect of the USPSTF guidelines on these additional investigations.

Click to read the study in JCO

Relevant Reading: Mortality results from a randomized prostate-cancer screening trial

In-Depth [cross-sectional study]: This study from the National Health Interview Survey (NIHS) involved a large, interview-based population survey performed annually in the United States. The study included men 40 years or older without a history of prostate cancer, who knew what a PSA test was and saw a physician within a year prior to survey. An externally validated mortality index was used to determine screening rates of men with less than 10 years of life expectancy. The study compared the screening rates from the survey results in 2005, 2010, and 2013. At the conclusion of the study, there was a significant reduction in the screening frequency from 2010 to 2013 in all men, with the exception of those aged 40-49. In the 50 to 59 years, screening was reduced from 33.2% in 2010 to 24.8% in 2013 (OR: 0.66; p= 0.01). In men 75 years and older, screening was reduced from 43.9% in 2010 to 37.1% in 2013 (OR: 0.75; p = -.03). Overall, 1.4 million men age 65 or older with a high risk of predicted 9-year mortality was screen for prostate cancer in 2013.

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