Drop in PSA Screening Rates After USPSTF Recommendations

December 2, 2015

Following the USPSTF recommendation in 2012 against routine PSA screening, rates of screening and the incidence of early-stage prostate cancer have both declined.

Prostate cancer screening has decreased following the 2012 US Preventive Services Task Force (USPSTF) recommendation against routine prostate-specific antigen (PSA) screening in men, according to a new study. The incidence of early-stage prostate cancer has also declined. These results are published in JAMA.

The study authors, led by Ahmedin Jemal, DVM, PhD, of the American Cancer Society (ACS), used data from the Surveillance, Epidemiology, and End Results program, identifying 18,385 men (age 50 and older) with newly diagnosed stage I prostate cancer who responded to the National Health Interview Survey in 2005, 2008, 2010, and 2013. The survey included self-reported PSA testing information.

PSA screening rates increased by 10% between 2005 and 2008. Following USPSTF recommendations against screening in men age 75 years and older, screening rates began to decrease in 2008. Rates decreased by 18% between 2010 and 2013, with the largest dip seen between 2011 and 2012.

Rates of screening were similar among both 50- to 74-year-old men and men 75 years and older. The percentage of men age 50 and older who reported having undergone PSA screening in the past 12 months was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013. Longer follow-up is needed to see whether these decreases are associated with trends in mortality, noted the study authors.

The researchers found an uptick in incidence of early-stage prostate cancer from 2005 to 2008 followed by a decrease of 23% by the end of 2012.

Alternative explanations for the decrease in incidence are unlikely. “There are no known strong risk factors for prostate cancer, for which temporal changes are likely to affect incidence, particularly for early-stage disease,” wrote Jemal and coauthors. “Change in access to care is unlikely to be responsible because the percentage of people with health insurance was similar between 2011 and 2012,” noting that there also have been no recent changes in Medicare coverage of PSA testing.

A prior study found a similar trend of decreased screening among men 50 years of age and older.

In 1992, the American Urological Association (AUA) and the ACS recommended annual screening for men 50 years and older. In 2008, the USPSTF recommended against PSA screening for men 75 years and older. In 2012 the task force broadened its recommendation, guiding against PSA screening in men who have no symptoms or are not at high risk of prostate cancer based on available evidence. The task force reasoned that the potential benefit of screening did not outweigh the harms associated with screening, including overdiagnosis and repeat biopsy.

Unlike the USPSTF, the AUA recommends PSA screening for asymptomatic men between the ages of 55 and 69, and the ACS recommends screening for men older than age 50 with a minimum 10-year life expectancy.