Influence of publication of US and European prostate cancer screening trials on PSA testing practices.

Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98101,USA.
CancerSpectrum Knowledge Environment (Impact Factor: 14.07). 02/2011; 103(6):520-3. DOI: 10.1093/jnci/djr007
Source: PubMed

ABSTRACT In 2009, results from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial indicated no difference in mortality between the screening and the control groups (rate ratio = 1.13, 95% confidence interval = 0.75 to 1.70), whereas those from the European Randomized study of Screening for Prostate Cancer trial indicated a 20% reduction in mortality among the screening group (rate ratio = 0.80, 95% confidence interval = 0.65 to 0.98). In this study, we examined whether prostate-specific antigen (PSA) testing has changed following these publications. The primary outcome measure was the proportion of men seen at least once in a primary care or urology clinic between August 1, 2004, and March 31, 2010, who received a PSA test. Following the publications, PSA use declined slightly-by 3.0 percentage points and 2.7 percentage points among men aged 40-54 and 55-74 years, respectively. PSA testing among men older than 75 years initially declined slightly following the recommendations by the US Preventive Services Task Force in 2008 and continued to decline after the trial publications.

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    ABSTRACT: The population-level data demonstrate that the inception of prostate-specific antigen (PSA) screening has lowered mortality for prostate cancer over the past 2 decades. However, more recent evidence from randomized trials has presented conflicting results regarding the benefit of PSA screening for prostate cancer mortality. Using available data, the U.S. Preventative Services Task Force recently recommended against PSA screening for prostate cancer. However, prostate cancer continues to kill over 30,000 men annually, and as such, completely abandoning screening for this disease is a disservice to many patients. Rather, the emphasis should be on utilizing evidence-based medicine to reduce overdiagnosis and overtreatment through less frequent screening for low-risk individuals or those unlikely to benefit from screening, halting further screening when appropriate, and utilizing observational strategies in patients unlikely to suffer clinically significant effects of prostate cancer over their anticipated life expectancy.
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    ABSTRACT: BACKGROUND: The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer. METHODS: We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007. RESULTS: Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p < .001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results. CONCLUSIONS: PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing.
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