Revised guidelines that no longer favor prostate cancer screening using the prostate-specific antigen (PSA) test, issued in 2012, have resulted in a decrease in PSA screenings among men age 75 or older but not in overall prostate cancer screening rates. These findings, part of a study titled “Contemporary national trends of prostate cancer screening among privately insured patients in the United States,” were presented at the American Society of Clinical Oncology‘s (ASCO) 2015 meeting in Chicago, Illinois.
“With the most recent changes in 2012, the U.S. Preventive Services Task Force (USPSTF) essentially recommended against screening any men for prostate cancer with a digital rectal exam or PSA for men of average risk of getting prostate cancer. They gave it a grade D recommendation,” Simon Kim, MD, MPH, assistant professor of urology and urologic oncology at University Hospital Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio, and a study investigator, said in a news release. “[There were] two trials that showed really mixed level evidence [regarding screening]. I think the controversy is because one trial showed no benefit and the other did.”
The population-based data was taken from Optum Labs Data Warehouse, a database from private health insurance claims. Using this database, the researchers retrieved information from 11.6 million eligible men, age 40 to 80 years. Of these, 2.9 million underwent screening for prostate cancer between 2008 and 2013. The majority of those screened were white, between 50 and 59 years of age, and living in the Southern census region.
The results revealed that the rate of men undergoing PSA screening was consistent during these years (190.4 per 1,000 member-years in 2008 to 196.4 in 2013) and reasonably stable among men age 50 to 74, with no variance among racial groups or by geographic region. However, there was a clear decrease in PSA screening among men age 75 or older, dropping from 201.5 per 1,000 member-years in 2008 to 124.1 in 2013.
“One positive impact of the reduction in prostate cancer screening in patients with advanced age is that there will be [fewer] unnecessary biopsies and potential complications of biopsies, as well as potentially reducing the rate of over-diagnosis of prostate cancer,” Dr. Kim said. “I think that all urologists, radiation oncologists, medical oncologists and primary care providers need to understand that there is an over-diagnosis of prostate cancer. In patients who are older who probably will not benefit from treatment, it’s beneficial that you do not need to screen patients.”