Prostate cancer screening practices in a large, integrated health system: 2007–2014

Abstract

Objectives To assess prostate cancer (PCa) screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate specific antigen (PSA) testing for older men, and to assess primary provider variation associated with PCa screening. Patients and Methods Our study population included 160, 211 men age >= 40 with at least 1 visit in a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 through December 2014. Yearly rates of screening PSA testing by primary care provider (PCP), rates of rescreening and rates of prostate biopsies were assessed. Results Annual PSA screening testing declined from 2007 to 2014 in all age groups as did biennial and quadrennial screening. Yearly rates declined for men >= age 70, from 22.8 % to 8.9 %, ages 50–69, from 39.2 % to 20 % and ages 40–49, from 11 % to 4.6 %. Overall rates were lower for African American men vs. non-African American men; for men with a family history of PCa, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA did not substantially change following the USPSTF recommendations. While the number of men screened and rates of follow-up PCa screening declined in 2011–2014 compared to 2007–2010, similar rescreening rates were noted for men age 45–75 with initial PSA levels < 1ng/ml or 1–3 ng/ml in both the earlier and later cohorts. For men age > 75 with initial PSA level < 3 ng/ml screened in both cohorts, follow-up screening rates were similar. Rates of prostate biopsy declined for men >=age 70 in 2014 compared to 2007. For men who had PSA screening, rates of first prostate biopsy increased in later years for African American men and men with a family history of PCa. Conclusions PCa screening declined from 2007 to 2014 even in higher risk groups and follow-up screening rates were not related to previous PSA level. However, rates of first prostate biopsy for men who had a PSA were higher for men with increased risk for PCa in later years. Variation in PSA testing was noted among PCPs. Future work should further explore sources of variation in screening practices and implementation of risk-based strategies for PCa screening in primary care.

Prostate-specific antigen screening: An update of physician beliefs and practices

“…Regardless of training, the majority (61%) of PCPs in our sample only offered and recommended a PSA test to some patients after taking individual risk and other factors into account rather than routinely screening all men. This behavior is consistent with the recommendations of professional organizations (Qaseem et al, 2013; American Urological Association) against routine screening for prostate cancer for all men, mirrors the overall decline in use of the PSA test by PCPs since 2000 (Schmidt, 2017; Misra-Hebert et al, 2017), and acknowledges PCP consideration of individual patient factors as well as patient preferences and values that may influence each screening decision. Some PCPs continue to routinely screen asymptomatic men for prostate cancer, but the majority appear to practice more in line with the 2012 recommendation.…”

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

“…Moreover, one study conducted in a group of primary care clinics concluded that the USPSTF guideline was not followed in such a way that the no-screening message was brought equally to all men; men with a family history were more likely and African American men less likely to be screened, and older men received a more balanced counselling on PSA testing. 38 …”

Metastatic prostate cancer incidence in Australia after amendment to prostate‐specific antigen screening guidelines

“…One of the implications of the category ‘D’ assigned to PSA screening by the USPSTF guidelines was a substantial universal decline in PSA screening across all age groups . This trend in decreased PSA screening across all age groups has indeed been the case in Australia as well .…”