PSA Screenings for Prostate Cancer Continue in US Despite Task Force’s Opposition

PSA Screenings for Prostate Cancer Continue in US Despite Task Force’s Opposition

Although the U.S. Preventive Services Task Force advised against prostate-specific antigen (PSA) screening for prostate cancer in 2012, arguing it led to excessive treatment, no significant reduction in the use of these tests is evident, according to a study of PSA practices at a major medical center in the years just before and after the recommendation was announced.

The study, “Testing and referral patterns in the years surrounding the US Preventive Services Task Force recommendation against prostate-specific antigen screening,” published in Cancer, was based on electronic medical records of more than 275,000 visits by men to the University of Texas Southwestern Medical Center.

“We used actual, real-world data and found that changes in PSA use, if any, are likely small,” Dr. Yair Lotan, professor of Urology, chief of Urologic Oncology, and a member of UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, said in a press release. “Many recent studies have claimed that the task force recommendations against PSA screening have caused a major change in prostate cancer screening. These studies were based on data sources including surveys, which could be subject to significant bias.”

Prostate cancer is the second leading cause of cancer death among men in the U.S. Since the 1990s, prostate cancer screenings nationwide have relied on PSA measurements and, despite a 39 percent drop in prostate cancer mortality since that time, the potential for overtreatment has concerned clinicians, Lotan said. PSA tests can produce false negatives, resulting in unnecessary treatment and risking side effects that include erectile dysfunction and urinary incontinence.

“In May 2012, the US Preventive Services Task Force (USPSTF) issued a grade D recommendation against the use of PSA-based screening for prostate cancer in men of all ages,” the researchers wrote. “It concluded that the harms of overtreatment outweigh the benefits of early detection.”

Researchers examined clinician behavior before and after the task force recommendation, using an institution-wide sample of PSA orders and referrals. Of the more than 275,000 patient visits analyzed, they found more than 63,700 PSA test requests from 2010 to 2015 — of which 54,684 were evaluated for the study.

Results revealed that the number of tests ordered for both inpatient and outpatient services was similar before and after the 2012 recommendation. Researchers also noted that, after the new guidelines, patients referred for testing had “progressively higher” PSA levels than was common earlier, but did not believe the change seen in levels affected patient outcomes.

“The number of PSA tests per ambulatory visit, the number of referrals per ambulatory visit, the age at the time of the urology referral, and the proportion of PSA tests performed outside the recommended age range did not significantly change” between 2010 and 2015, they wrote.

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One comment

  1. Chris O'Neill says:

    “despite a 39 percent drop in prostate cancer mortality since that time, the potential for overtreatment has concerned clinicians, Lotan said.”

    It is misleading to just point out the observation of a drop in mortality over a particular period since there are many other changing variables in that period that could have had an effect on mortality.

    The actual reason for concern about over treatment is that randomised controlled trials (which reduce the impact of confounding variables) have failed to show any significant improvement in overall survival from increases in PSA screening and consequent increases in treatment.

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