Prostate-specific antigen testing after the US Preventive Services Task Force recommendation: a population-based analysis of electronic health data

Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation on Prostate Cancer Screening

“…Similar patterns of prompt decreases in testing were seen after the draft publication of the grade D recommendation in 2011, indicating continued responsiveness to subsequent changes. 6,7,9 Considerable early increases in PSA testing likely reflected high levels of awareness that have been amplified by media attention and controversies surrounding the USPSTF recommendations. 23,24 In the intervening years leading up to the 2017 draft statement, a range of prostate cancer stakeholders, including advocacy groups, politicians, and celebrities, continued to encourage screening.…”

“…We found that changes in PSA testing were implemented rapidly and were temporally associated with the publication of the draft guideline more so than with the final version published more than 1 year later. Similar patterns of prompt decreases in testing were seen after the draft publication of the grade D recommendation in 2011, indicating continued responsiveness to subsequent changes . Considerable early increases in PSA testing likely reflected high levels of awareness that have been amplified by media attention and controversies surrounding the USPSTF recommendations .…”

“…At the time, the guideline expressed moderate to high certainty that the harms of PSA screening outweighed the benefits . In the subsequent period, the guideline was rapidly incorporated into practice, and there have been measurable decreases in rates of PSA testing and diagnostic biopsies, as well as the number of prostate cancers identified in the United States . There are also increasing concerns that reductions in PSA testing associated with the USPSTF statement were temporally associated with increases in the incidence of prostate cancers diagnosed at an advanced or metastatic stage …”

“…3,4 In the subsequent period, the guideline was rapidly incorporated into practice, and there have been measurable decreases in rates of PSA testing and diagnostic biopsies, as well as the number of prostate cancers identified in the United States. [5][6][7] There are also increasing concerns that reductions in PSA testing associated with the USPSTF statement were temporally associated with increases in the incidence of prostate cancers diagnosed at an advanced or metastatic stage. 8,9 In April 2017, the USPSTF published a draft guideline that reversed prior guidance against routine screening for prostate cancer, issuing a grade C recommendation for men aged 55 to 69 years that the decision to undergo periodic PSAbased screening for prostate cancer should be an individual one, based on a discussion of the potential benefits and harms.…”

Long-Term Impact of Medicaid Expansion on Prostate Cancer Screening

“…Our finding is also supported by previous population-based analyses using data from large US health care systems showing the 2012 guidelines were associated with a significant decline in PSA screening frequency in men of all races and ages 55 to 80. 22 While the 2012 guidelines may have had its intended policy effect of decreased PSA screening among all men regardless of age and race, the study also notes this includes high-risk populations who could benefit from early PCa detection. 22 Notably, earlier studies found decreases in screening after the 2012 guidelines were most pronounced in younger and older patients, as well as those with a history of PSA values below 2.5 ng/mL, suggesting PCPs may be employing more selective screening practices.…”