Changes in Prostate Specific Antigen Screening and Prostate Cancer Diagnosis After Guideline Changes
Prostate cancer (CaP) is the most common cancer in men, yet consensus for screening practices is lacking. In 2012, the US Preventative Services Task Force (USPTF) recommended against Prostate Specific Antigen (PSA) screening across all age groups. We evaluated the impact of this recommendation on population level screening and stage of diagnosed CaP.
We identified men aged 35+ receiving care at our academic institute using electronic medical records. To assess the impact of the guideline recommendations, we compared changes in PSA screening rates among men undiagnosed with CaP before (2008-2011) and after (2013-2016) the USPTF recommendation with changes in the same period for cholesterol and thyroid-stimulated hormone (TSH) screening, which were unaffected by the USPSTF change, using a difference-in-differences analysis adjusted for secular trends, age, race, insurance, and comorbidities. The 2012 data were excluded as a washout year.
We identified a total of 789,557 men eligible for screening on an annual basis: 264,265 pre- and 525,292 post-guideline changes, which included 2,839 and 1,609 new CaP diagnoses, respectively. Our models suggest that following USPTF changes, PSA screening had a significant relative decrease of 6.3% and 1.8% compared to cholesterol and TSH, respectively. The greatest decreases were observed among men < 55 (-6.7% and -3.3%) and > 75 years of age (-8.0% and -1.5%). Regarding CaP diagnoses, 74.3% were early stage (T1/T2) pre-USPSTF compared to 66.4% post-USPSTF (p<0.0001). We observed declines in early stage diagnoses from 80% to 69% (p=0.021) in men < 55, 71% to 65% (p=0.007) in men 55-75, and 89% to 81% (p=0.285) in men > 75.
These results suggest PSA testing decreased among males aged 35 and older following the 2012 USPSTF guideline changes, and was accompanied by decreased diagnosis rates of low-risk, localized CaP. This study highlights the potential for guidelines to increase efficient and effective medical care and potentially reduce overtreatment in CaP patients, though the impact on CaP-specific survival is unknown.
Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA183962. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.