Article

Primary care physician PSA screening practices before and after the final U.S. Preventive Services Task Force recommendation

Section of Urology, University of Chicago, Chicago, IL.
Urologic Oncology (Impact Factor: 3.36). 08/2013; 32(1). DOI: 10.1016/j.urolonc.2013.04.013
Source: PubMed

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. "
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