It is 4 years since the US Preventive Services Task Force (USPSTF) published guidelines recommending against routine prostate-specific antigen (PSA)-based prostate cancer screening for all men. Yet questions still remain about the appropriate level of prostate cancer screening and referral.1
In an editorial published recently in Cancer, James T. Kearns, MD, and John L. Gore, MD, of the University of Washington in Seattle, reviewed several studies that evaluated rates of PSA screening throughout the country, and questioned whether the USPSTF guidelines have had an effect on practice patterns.2
“The thinking is, at least among urologists I work with, that the environment we are working in for prostate cancer today is a different environment than the Task Force based its recommendations off of,” Dr Kearns told Cancer Therapy Advisor.
At that time, active surveillance had not taken as big of a role in the management of prostate cancer, so a lot of men with low-volume, low-risk prostate cancer were getting prostatectomy and dealing with morbidity, Dr Kearns explained.
“In issuing this recommendation, the Task Force was trying to balance this morbidity with data showing that there was not much benefit of intervention or screening,” he said.
It is still too early to know exactly how these new PSA screening guidelines have affected rates of treatment for prostate cancer, or prostate cancer outcomes. Yet several studies have attempted to calculate whether PSA screening has changed since the publication of the USPSTF guidelines.
One study published in recently Cancer evaluated data on ambulatory visits to primary care physician, the number of PSA tests ordered, the number of urology referrals, and the PSA levels at the time of referral.3 The study showed that PSA testing rates and urology referrals did not significantly change from 2010 (prior to the USPSTF recommendation) to 2015.
In contrast, a study published in 2014 showed an 11% decrease in PSA testing for all men in a large community health system in the Midwest, but these data were driven largely by a decrease in screening in the youngest and oldest men in the study.4 Decreases in PSA screening began prior to the USPSTF recommendation. A 2015 study using data from the National Health Interview Survey similarly showed significant decreases in PSA screening between 2010 and 2013.5