PSA Testing Unchanged in Years After USPSTF Recommendation

Prostate-specific antigen (PSA) testing behavior did not significantly change in the years after a US Preventive Services Task Force (USPSTF) recommendation against PSA screening, according to a study published in Cancer.¹

In May 2012, USPSTF concluded that the harms of overtreatment outweigh the benefits of early detection of prostate cancer. A grade D recommendation against the use of PSA-based screening was issued for prostate cancer in men of all ages.

Studies assessing the effect of the USPSTF recommendation on PSA-based screening practices were limited by their duration, level of detail, and heavy reliance on patient-reported survey data. Investigators evaluated the impact of the USPSTF recommendation on PSA testing and urology referral behavior at a large tertiary care academic medical center.

Data from 275,784 men were analyzed.

Primary care providers ordered 17,315 PSA tests and 858 referrals to a urologist. There was no significant change in the number of PSA tests per ambulatory visit, the number of referrals per ambulatory visit, the age at the time of the urology referral, or the proportion of PSA tests performed outside the recommended age range between the years before the USPSTF recommendation and the years after the guidelines were published.

Patients’ PSA values at the time of referral, however, increased significantly in the years after the USPSTF recommendation.

It is hypothesized that habit, training, or disagreement with the USPSTF recommendations may be the cause for the continued use of PSA screening. A prospective trial is warranted to better understand factors associated with PSA utilization.                       

Reference

1. Hutchinson R, Akhtar A, Haridas J, Bhat D, Roehrborn C, Lotan Y. Testing and referral patterns in the years surrounding the US Preventive Services Task Force recommendation against prostate-specific antigen screening. Cancer. 2016 Sep 22. doi: 10.1002/cncr.30330 [Epub ahead of print]