Mp39-06 Impact of Guidelines on Prostate Cancer Screening in a Population-Based Setting, 2000-2014: Preliminary Results From the First Aua Data Grant

The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

“…Other guidelines recommend starting at age 45 12, 34, 35 , due to growing evidence that an elevated baseline PSA can be predictive of future lethal disease 36 . Despite these discrepancies, when PSA screening rates following the 2012 recommendation were stratified by age, decreases were noted across all groups, including those for which screening may be most beneficial 6, 18, 20, 21, 24, 25, 29, 31–3326 . Drazer et al ., using the NHIS, reported that for men aged 50–59, rates of screening decreased from 33.2% to 24.8% from 2010–2013; for men 60–74, screening decreased from 51.2% to 43.6%; and for men ≥75, screening decreased from 43.9% to 37.1% 6 .…”

“…Furthermore, these two age groups were less likely to be screened in 2013 than 2010, with an odds ratio (OR) of 0.71 (95% CI 0.66–1.10) for 50–54 and 0.69 (95% CI 0.54–0.89) for 60–64. Likewise, examination of population-based institutions in Michigan and Massachusetts found PSA testing rates in these states increased to 27% and 32%, respectively, between 2000–2008, with subsequent decreases to a mean of 25% in 2009–2012 and 23% in 2013–2014 18 . Stratification by age produced similar decreases in both the 55–69 and ≥70 populations, at 33% and 31%, respectively.…”

“…also reported a 25% decrease in PSA screening among men at higher risk for developing PC because of African-American race and/or family history of PC. 18 Nevertheless, Turini et al ., using 2012 BRFSS data, found that despite the USPSTF recommendation, African-American men still had higher odds of being screened compared with white men (OR 1.51; 95% CI 1.37–1.67) 27 . Moreover, one study conducted in a group of primary care clinics concluded that the USPSTF guideline was not followed in such a way that the no-screening message was brought equally to all men; men with a family history were more likely and African American men less likely to be screened, and older men received a more balanced counselling on PSA testing.…”

“…There is now an aggregated body of evidence that, in the years following the 2012 USPSTF recommendation, fewer younger men, who may benefit from being screened, are being screened (under-screening), while there is still a substantial proportion of older men being screened, most likely without benefit (over-screening). Men at high risk of developing PC also received less screening 18, 27 , possibly a consequence of a lack of special recommendation for this population. While some physicians are inclined to adopt risk-stratified screening practices through further clinical workup to ascertain disease aggressiveness and longer screening intervals for patients with low PSA levels 32, 45 others have opted to indiscriminately abandon the practice altogether.…”

PSA Screening for Prostate Cancer in Men under the Age of 65: A Review of Current Practice

“…Hereditary Prostate Cancer Gene 1 (HPCG1) mutations and inherited mutations in other genes such as Breast Cancer Susceptibility Genes (BRCA1, BRCA2, and HOXB13) account for some cases of hereditary disease[5]. Men with BRCA2 or HOXB13 gene mutations may have a high risk of developing more aggressive, life-threatening Prostate Cancer[5].Approximately 15% of Adenocarcinoma of the Prostate is likely to be due to germline factors[7]. GWAS focusing on men under the age of 55 with early-onset disease have revealed several Single Nucleotide Polymorphisms (SNPs) in the germline DNA associated with an increased risk in these populations[5] Female carriers of the BRCA1 and 2 mutations are at risk for developing breast and ovarian carcinomas and these mutations predispose male carriers to the development of Adenocarcinoma of the Prostate [10][32].…”