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Prostate cancer screening rates have stabilized in recent years

Although the rate of PSA testing for prostate cancer in the United States declined between 2010 and 2013, screening rates remained stable between 2013 and 2015, with one-third of men aged 50 years and older receiving testing. Further investigation on how testing patterns affect long-term outcomes of prostate cancer is warranted, according to a research letter published in JAMA Internal Medicine.

“Recommendations for [PSA]-based prostate cancer screening have changed considerably in recent years,” Stacey A. Fedewa, PhD, of the American Cancer Society, and colleagues wrote. “In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against PSA-based prostate cancer screening among men 75 years or older, and in 2012, they recommended against PSA testing for men of all ages. Other organizations emphasize shared-decision making for men 50 years or older with a long life expectancy. As a result of shifting recommendations, PSA screening rates declined from 37.8% in 2010 to 30.8% in 2013 among men 50 years or older, resulting in substantial declines in prostate cancer incidence.”

Fedewa and colleagues evaluated PSA testing patterns since 2013 using data from the 2015 National Health Interview Survey (NHIS). They included 16,196 men aged 50 years or older who participated in the 2010, 2013 and 2015 NHIS, excluding men who reported a history of or who were missing data on prostate cancer diagnosis or PSA testing or who had PSA testing for nonscreening reasons.

A total of 75% of participants reported visiting their PCP in the past year. In this study, unadjusted screening rates indicated that between 2010 and 2013, PSA testing for routine reasons among men aged 50 years or older declined from 38.3% to 31.5% (P < .001), in line with previously reported average incidence. Through 2015, the screening rate remained stable, at 32.1% (P = .62). The results were similar in analyses adjusted for sociodemographic factors, insurance and health care characteristics, with significantly lower PSA testing rates in the past year in 2013 than 2010 (screening rate ratio [SRR] = 0.83; 99% CI, 0.77-0.89), but no significant difference between 2013 and 2015 (SRR = 0.99; 95% CI, 0.91-1.08). This pattern was similar across all age groups.

These findings suggest that “physicians interested in deadopting PSA testing may have done so, closely following the USPSTF recommendation and the media attention that came with it,” Fedewa and colleagues concluded. “In addition, other public health organizations still support PSA testing, albeit with shared decision making, and physicians may have chosen to continue to offer PSA testing based on their beliefs about screening and interpretation of clinical trial results. We relied on self-reported PSA testing, which is subject to recall bias, and some men may not have been informed of testing, which is a limitation of the study. However, this study provides data on contemporary nationwide PSA testing patterns.”

The USPSTF recently changed its recommendation on prostate cancer screening. – by Alaina Tedesco

Disclosure: The study was supported by the American Cancer Society.