PSA Screening Rates Are No Longer Dropping

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CURE, GU Special Issue, Volume 1, Issue 1

After a drop, the frequency of PSA screening for prostate cancer has stabilized.

THE FREQUENCY OF BLOOD tests to check levels of prostate-specific antigen as a screen for prostate cancer is no longer dropping, according to the results of a recent nationally representative study published in JAMA Internal Medicine.

The test is not being conducted quite as frequently as it was before the drop, but numbers have leveled off, with approximately one-third of men aged 50 or older receiving routine PSA tests, the researchers found.

In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against PSA-based prostate cancer screening among men 75 or older, and in 2012, it recommended against routine testing for men of all ages. Possibly as a result, PSA screening rates declined from 37.8 percent in 2010 to 30.8 percent in 2013 among men 50 or older.

The task force recently suggested that men aged 55 to 69 should speak to their doctors about whether to screen, but its earlier recommendation against the imprecise screening test was meant to prevent overtreatment of prostate cancer — invasive testing or treatment in men who either don’t have the disease or in whom the cancer would never cause a problem if left alone.

As expected, the recommendations resulted in substantial declines in reported prostate cancer incidence. However, another recent study suggests that this decline may have led to some treatable cancers being overlooked until they became advanced.

That study revealed a modest short-term increase (from 2011 to 2013) in the incidence of metastatic prostate cancer and a significant increase in distant metastases at diagnosis in men 75 or older. Its authors noted that this may have been a result of the 2008 and 2012 USPSTF recommendations against prostate cancer screening in this patient population. The researchers also found that, in participants younger than 75, the proportion of men who had distant metastases at diagnosis increased from 2.7 percent to 4 percent, and the proportion with intermediate- and high-grade prostate cancers at diagnosis from rose 46.3 percent to 56.4 percent.

In the JAMA study of PSA screening rates, investigators gathered data on 19,690 men aged 50 or older from the 2010, 2013 and 2015 National Health Interview Survey databases. A total of 16,196 men were included in the analysis, after the exclusion of those who reported a history of (or were missing data on) prostate cancer diagnosis (1,115 men) or PSA testing (1,574) or who had undergone PSA testing for non-screening reasons (805).

Of the 16,196 respondents, more than half (59 percent) were aged 50 to 64; 26 percent were 65 to 74; and 15 percent were older than 75. While data was missing for 10 respondents, 75 percent had visited a primary-care physician in the past 12 months. Among men 50 or older, unadjusted routine PSA testing rates in the past year decreased from 38.3 percent in 2010 to 31.5 percent in 2013 and then remained stable at 32.1 percent through 2015.

Adjusted analyses were similar, with PSA testing in the past year significantly lower in 2013 than in 2010 but not significantly different between 2015 and 2013. That pattern was similar across age groups.

The researchers concluded that previously reported declines in PSA testing have not continued in recent years, with approximately a third of men aged 50 or older still receiving routine testing, and noted the need for continued evaluation on how testing patterns influence prostate cancer outcomes over the long term.