USPSTF 2012 Screening Recommendations May Have Affected Prostate Cancer Testing

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The impact of USPSTF recommendations on the incidence and management of prostate cancer have not yet been fully explored.
The impact of USPSTF recommendations on the incidence and management of prostate cancer have not yet been fully explored.

Reductions in diagnostic testing, incidence, and local treatment for prostate cancer (PCa) were observed between 2008 and 2014 in alignment with the 2012 United States Preventive Service Task Force (USPSTF) recommendations against routine PCa screening, according to a study published in Cancer.1

Previous findings have shown that the treatment of clinically insignificant PCa by means of prostatectomy or radiotherapy has led to morbidity and worsened quality of life among men, leading the USPSTF to recommend against the routine screening of prostate cancer. The impact of these recommendations on the incidence and management of PCa, however, have not yet been fully explored.

In this study, investigators accessed the MarketScan database and collected data of more than 30 million men who were 40 to 64 years old with private insurance between 2008 and 2014. Researchers then quantified the rate of prostate specific antigen (PSA) screening, prostate needle biopsy, the incidence of prostate cancer, and prostate cancer treatment.

Of the patients in the MarketScan database, approximately 6 million men had at least 1 full year of evaluable data for the study.

Results showed that PSA testing, prostate biopsy, and prostate cancer detection rates significantly decreased between 2009 and 2014, most notably after 2011.

The rate of prostate biopsy per 100 patients with a PSA test decreased from 1.95 (95% CI, 1.92-1.97) to 1.52 (95% CI, 1.50-1.54) over the study period. The incidence of PCa per prostate biopsy increased over the study period from 0.36 (95% CI, 0.35-0.36) to 0.39 (95% CI, 0.39-0.40). The proportion of newly diagnosed PCa treated with definitive local therapy decreased to 54% (95% CI, 53-55) from 69% (95% CI, 69-70). Both the incidence of PCa incidence and PSA testing significantly decreased after 2011 (P < .001).

The authors concluded that “given the proportionately greater decrease in prostate biopsy, prostate cancer incidence, and treatment of prostate cancer, this decrease may be driven by differential referral patterns for elevated PSA levels from primary care providers to urologists.”

Reference

  1. Kearns JT, Holt SK, Wright JL, et al. PSA screening, prostate biopsy, and treatment of prostate cancer in the years surrounding the USPSTF recommendation against prostate cancer screening [published online May 21, 2018]. Cancer. doi: 10.1002/cncr.31337

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