Guideline change triggers increased PSA screening
medwireNews: Rates of prostate-specific antigen (PSA) testing have increased significantly since 2017, following the publication of guidelines reversing a previous recommendation against routine prostate cancer screening in young men, US researchers report.
In 2011, a US Preventive Services Task Force (USPSTF) guideline “expressed moderate to high certainty that the harms of PSA screening outweighed the benefits,” explain Michael Leapman (Yale University School of Medicine, New Haven, Connecticut, USA) and colleagues.
However, in April 2017, following concerns about increasing incidence of late-stage prostate cancer, the USPSTF published a draft guideline with a grade C recommendation endorsing individual decision-making on PSA testing for men aged 55 to 69 years. This was finalized in May 2018 but PSA testing for patients aged 70 years and older was still discouraged.
To assess the impact of these changes, Leapman and team looked at age-adjusted PSA testing rates in bimonthly periods using claims-based data for a median of over 8 million eligible beneficiaries aged 40 to 89 years per period.
They report in JAMA Oncology that the mean rate of PSA testing increased from 32.5 tests per 100 person–years in 2016 to 36.5 tests per 100 person–years in 2019, corresponding to a relative 12.5% increase.
In addition, the relative increase in PSA testing from 2016 to 2019 was 10.1% (20.6 to 22.7 tests per 100 person–years) among men aged 40 to 54 years, 12.1% (49.8 to 55.8 tests per 100 person–years) among those aged 55 to 69 years, and 16.2% (38.0 to 44.2 tests per 100 person–years) among men aged 70 to 89 years.
Furthermore, an interrupted time series analysis revealed that the trend for PSA testing increased significantly after April 2017 among all age groups. The rates of increase were 0.15, 0.31, and 0.65 tests per 100 person-years for each bimonthly period in individuals aged 40 to 54, 55 to 69, and 70 to 89 years, respectively.
Leapman et al conclude: “By identifying appreciable early increases in PSA testing rates, this work can directly inform estimates of the outcome of the USPSTF statement change, signaling a reversal in early detection practices.”
They add: “The findings of increased screening outside of target age categories, including those for whom screening remains discouraged by the task force and other clinical guidelines, can again focus efforts to improve the quality of prostate cancer screening.”
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