Primary care physician PSA screening practices before and after the final U.S. Preventive Services Task Force recommendation
ABSTRACT In May 2012, United States Preventive Services Task Force (USPSTF) finalized its recommendation against prostate-specific antigen (PSA) screening in all men. We aimed to assess trends in PSA screening frequency amongst primary care physicians (PCPs) surrounding the May 2012 USPSTF recommendation.
The electronic data warehouse was used to identify men aged between 40 and 79 years with no history of prostate cancer or urology visit who were evaluated by an internal medicine or family practice physician between 2007 and 2012. Analyses were directed toward PSA testing within 6-month time period from June to November, with particular focus on the 2011 (pre-USPSTF recommendation) and 2012 (post-USPSTF recommendation) cohorts. The primary outcome measure was proportion of men with at least 1 PSA test during the 6-month pre- and post-USPSTF recommendation periods.
A total of 112,221 men met inclusion criteria. There was a significant decrease in screening frequency between the 2011 and 2012 cohorts (8.6% vs. 7.6%, P = 0.0001; adjusted odds ratio 0.89, 95% confidence interval 0.83-0.95). This decrease was most evident amongst patients aged 40 to 49 years (5.6% vs. 4.6%, P = 0.004) and 70 to 79 years (7.9% vs. 6.2%, P = 0.01). A significant decrease was also observed in patients with highest previous PSA value<1.0 (P<0.0001) and 1.0 to 2.49ng/ml (P = 0.0074).
Since the USPSTF recommendation was finalized, there is evidence of continuing decreases in PSA testing by PCPs. PCPs may be shifting toward more selective screening practices, as decreases in screening are most pronounced in the youngest and oldest patients and in those with history of PSA values<2.5ng/ml.
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- "Although in 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against PSA-based screening based on recent PSA screening trials indicating that PSA-based screening resulted in little or no reduction in PCa mortality or all-cause mortality (Andriole et al., 2009; Moyer & USPSTF, 2012), the recommendation appears to have had little impact on rates of PSA-based screening. A recent study demonstrated that 7.6% of men received PSA-based screening in the 6 months after the recommendation was released, compared with 8.6% in the 6 months prior (Cohn et al., 2014). As many men are continuing to receive PSA-based screening, it is important to understand its psychological risks and benefits and to develop strategies for mitigating risks. "
ABSTRACT: A significant proportion of men, ages 50 to 70 years, have, and continue to receive prostate specific antigen (PSA) tests to screen for prostate cancer (PCa). Approximately 70% of men with an elevated PSA level will not subsequently be diagnosed with PCa. Semistructured interviews were conducted with 13 men with an elevated PSA level who had not been diagnosed with PCa. Uncertainty was prominent in men's reactions to the PSA results, stemming from unanswered questions about the PSA test, PCa risk, and confusion about their management plan. Uncertainty was exacerbated or reduced depending on whether health care providers communicated in lay and empathetic ways, and provided opportunities for question asking. To manage uncertainty, men engaged in information and health care seeking, self-monitoring, and defensive cognition. Results inform strategies for meeting informational needs of men with an elevated PSA and confirm the primary importance of physician communication behavior for open information exchange and uncertainty reduction. © The Author(s) 2015.American journal of men's health 05/2015; DOI:10.1177/1557988315584376 · 1.15 Impact Factor
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ABSTRACT: The U.S. Preventative Services Task Force (USPSTF) recently recommended against routine prostate cancer screening, stating the risks of screening outweigh the benefits. Our objective was to determine the impact this recommendation had on prostate cancer screening in a large health system. We obtained data on all screening prostate-specific antigen (PSA) tests performed at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012. The total number of PSA tests ordered over time, adjusted for patient volume, was examined by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban, rural), patient age, and provider type (primary care, urology). Overall, 43,498 screening PSA tests were performed (January 2008-December 2012). The majority of these were ordered by internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%). PSA screening increased over time until March 2009 when initial PSA screening trials were published. PSA use decreased significantly and became more dramatic after USPSTF recommendations. Similar patterns were noted in nearly all subgroups. The greatest decrease in PSA screening was observed in urban teaching hospitals, urologists, and patients in the intermediate age group (50-59 years). USPSTF recommendations appeared to decrease prostate cancer screening. The greatest impact was seen in urologist and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on screening, diagnosis, treatment and prognosis of this prevalent malignancy.The Journal of urology 12/2013; 191(6). DOI:10.1016/j.juro.2013.12.010 · 3.75 Impact Factor
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ABSTRACT: This article presents an overview of the challenges that men encounter in making decisions about prostate cancer screening, including complex affective and cognitive factors and controversies in the interpretation of the evidence on prostate cancer screening. Shared decision making involving patient decision aids are discussed as approaches that can be used to improve the quality of prostate cancer screening decisions, including a close alignment between a man's values, goals, and preferences and his choice about screening.Urologic Clinics of North America 05/2014; 41(2):257-266. DOI:10.1016/j.ucl.2014.01.008 · 1.35 Impact Factor