Testing and referral patterns in the years surrounding the US Preventive Services Task Force recommendation against prostate‐specific antigen screening

Abstract

In the years surrounding the USPSTF recommendation, PSA behavior did not change significantly. Patients were referred at progressively higher average PSA levels. The implications for prostate cancer outcomes from these trends warrant further research into provider variables associated with actual PSA utilization. Cancer 2016;122:3785-3793. © 2016 American Cancer Society.

PSA screening, prostate biopsy, and treatment of prostate cancer in the years surrounding the USPSTF recommendation against prostate cancer screening

“…Cohn et al reported on the practice patterns of a large Midwest health system and demonstrated an 11% decrease in PSA testing ordered by internal medicine and family practice physicians in the 6 months after the USPSTF guideline statement. Although Hutchinson et al observed negligible changes in PSA testing rates among primary care providers in a Southwest health system, their finding of increased PSAs at the time of urology referral supports our hypothesis of primary care retention of positive PSA screens. US population‐based survey and cancer registry data similarly support decreased PSA screening and decreased diagnoses of early prostate cancer .…”

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

“…found a 19% decrease in urologic referrals for elevated PSA 43 , and Hutchinson et al . found that although PSA testing rates did not change at their institution, PCPs were referring patients at increasingly higher PSA values, at an average of 2.56 ng/ml in 2012, 2.72 ng/mL in 2013, 3.06 ng/ml in 2014 and 3.84 ng/ml from 2015 onwards 39 . Dalela et al .…”

“…found that within their regional hospital network (2008–2012), 64.9% of PSA tests were ordered by internists and 23.7% by family physicians, while only 6.1% were ordered by urologists and 1.3% by hematologist/oncologists 17 . Several studies looked at differences in PSA test ordering among PCPs 21, 25, 26, 28, 31, 32, 39 . Using the National Ambulatory Medical Care Survey (NAMCS), Shoag et al .…”

“…However, this might concurrently lead to more men with PC being diagnosed at later stages, once their cancers have precipitated symptoms that would justify clinical investigation. Indeed, increased rates of advanced disease upon detection were noted 43 , characterized by increased pre-biopsy PSA levels 39, 43, 44 higher Gleason scores 43, 50, 64 and more advanced clinical TNM stage 44, 46 . This risk-group/stage migration towards higher risk, more advanced PCs may be indicative of more appropriate selection of men for prostate biopsy.…”

Prostate cancer in black men: Is it time for personalized screening approaches?

“…In addition, studies have noted decreases in the rates of diagnosis of early stage disease . Disturbingly, early data suggest there may be an increase in high‐risk disease, but use associated with PSA, including subsequent referrals, urology visits, and treatments, may not have changed much . Although it is possible that this may be because of the more discriminate use of PSA screening among men who physicians believe are most likely to benefit from early detection, it is concerning that the current recommendations may result in decreased screening and diagnosis rates in higher‐risk men who are most likely to benefit from early detection and to require subsequent treatment.…”