Subsequent to the 2012 U.S. Preventative Services Task Force recommendation discouraging prostate-specific antigen (PSA)-based screening, prostate cancer screening significantly declined among men age 50 years and older in the United States, according to a study published online in the Journal of Clinical Oncology.
Based on National Health Interview Surveys in 2005, 2010, and 2013, self-reported PSA-testing levels decreased most among men aged 50-59 years, from 33.2% in 2010 to 24.8% in 2013 (odds ratio, 0.66; P < .01). Declines from 2010 to 2013 were also observed among men aged 60-74 years (51.2%-43.6%; OR, 0.74; P < .01); and aged 75 and older (43.9%-37.1%, OR, 0.75; P = .03). Among men aged 40-49 years, the decline from 12.5% to 11.2% was not significant (Journ. Clin. Onc. 2015 June 8 [doi:10.1200/JCO.2015.61.6532]).
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The declines may reflect increased adherence by physicians to USPSTF guidelines; nevertheless, in 2013 approximately one-third of men aged 65 or older who had high risk for 9-year mortality (about 1.4 million individuals) were screened.
“Persistently elevated screening rates among men with limited remaining life expectancies are troubling and merit further interventions,” wrote Dr. Michael Drazer of the University of Chicago Medical Center and colleagues. “These may include increasing awareness of initiatives such as Choosing Wisely recommendations from the American Society of Clinical Oncology and recommendations from the American Geriatrics Society,” they wrote.
If these efforts prove unsuccessful, reducing or eliminating reimbursements for screening and interventions may be considered, the authors suggest.
A multivariate model identified factors that predict which men over age 65 are likely to be screened, and these are men who went to college, were married, consumed alcohol, and received a colonoscopy in the last 10 years. They found no significant predictors in the patient population for declines in screening from 2010 to 2013.
Several studies support the use of extended screening intervals (every 2-3 years) for patients at low risk for prostate cancer. Annual screening of men aged 55-67 years has been estimated to result in a 50% overdiagnosis rate.
Drs. Drazer and Huo reported having no financial disclosures. Dr. Eggener reported having consulting or advisory roles with Myriad Genetics, Medivation, Janssen Pharmaceuticals, Genomic Health, OPKO Diagnostics, and MDxHealth.