Fewer Prostate Biopsies After USPSTF Limited PSA Screening

Following the 2012 USPSTF recommendation against PSA screening in populations, rates of radical prostatectomy and biopsy have become significantly less common.
Following the 2012 USPSTF recommendation against PSA screening in populations, rates of radical prostatectomy and biopsy have become significantly less common.

Following the 2012 United States Preventative Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) screening in populations, rates of radical prostatectomy and biopsy have become significantly less common. Further revisions about prostate cancer-related recommendations should take a “panoramic view” to avoid unintended consequences, according to a recent article in JAMA Surgery.1

The results of the PLOC (Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial; ClinicalTrials.gov Identifier: NCT00002540) led the USPSTF to recommend against population-wide screening for prostate cancer, despite its widespread occurrence in the US.2

For the present study, researchers reviewed case logs from physicians who performed a prostate biopsy or radical prostatectomy between 2009 and 2016. Between 2009 and 2012, the average number of biopsies per urologist was 29; these figure decreased to 21 between 2013 and 2016. The decrease was much greater among male urologists than among females.

Median rate of radical prostatectomy per urologist decreased by only 1 during the same timeframe.

The authors conclude that a “vantage point” is needed to accurately assess and predict the effects of USPSTF recommendations. Long term consequences may be broader than anticipated when guidelines are published; unintended consequences of previous revisions should therefore be taken into account when developing new recommendations.

References

  1. Halpern JA, Shoag JE, Artis AS, et al. National trends in prostate biopsy and radical prostatectomy volumes following the United States Preventative Services Task Force guidelines against prostate-specific antigen screening. JAMA Surg. 2016 Nov 2. doi: 10.1001/jamasurg.2016.3987 [Epub ahead of print]
  2. Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104(2):125–32. doi:  10.1093/jnci/djr500
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