Guidelines conflict regarding recommendations for prostate-specific
antigen (PSA) screening for early detection of prostate cancer. The United
States Preventive Services Task Force (USPSTF) assigned a grade of D
(recommending against screening) for men 75 and older in 2008 and for men of all
ages in 2012. We reviewed temporal trends in rates of screening before and after
the 2012 recommendation based on a literature search for studies published
between 2011/01/01–2016/10/03 on PSA utilization patterns, changes in
prostate cancer incidence and biopsy patterns, and how the recommendation has
shaped physician and patient attitudes about PSA screening and subsequent
ordering of other screening tests. Rates of PSA screening decreased by
3–10 percentage points among all age groups and within most U.S.
geographic regions. Rates of prostate biopsy and prostate cancer incidence have
declined in unison, with a notable shift towards higher grade, stage and risk
upon detection. Despite the recommendation, some physicians reported ongoing
willingness to screen appropriately selected men, and men largely reported
intending to continue to ask for the PSA test. In the coming years, we expect to
have a better picture of whether these decreased rates of screening will impact
prostate cancer metastasis and mortality.