Physicians in general have ordered fewer PSA screening tests following the 2012 release of a recommendation from the U.S. Preventive Services Task Force (USPSTF) against such testing, with the greatest decline seen among urologists.
In May 2012, the USPSTF advised against PSA-based screening for prostate cancer (PCa), having concluded “that there is moderate certainty that the benefits” of this practice “do not outweigh the harms.”
To assess the impact of the USPSTF recommendation in a large health system, a team led by Robert Abouassaly, MD, MSc, assistant professor of urology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center in Cleveland, evaluated data on PSA tests performed at the medical center and its affiliated hospitals in northeastern Ohio from January 2008 to December 2012.
The investigators found that most of the 43,498 screening PSA tests performed during the study period were ordered by specialists in internal medicine (64.9%), followed by specialists in family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%). After increasing with time, a drop-off in PSA screening was seen in March 2009, when the initial findings of both the National Cancer Institute’s Prostate, Lung, Colorectal, and Ovarian Screening Trial and the European Randomized Study of Screening for Prostate Cancer indicated that regular PSA screening did not reduce PCa deaths.
In a report published online ahead of print in The Journal of Urology Dr. Abouassaly’s group noted that PSA testing decreased significantly after the USPSTF recommendations came out.
The researchers examined overall trends by facility locations (urban, suburban, or rural), by patient age, and by provider type (primary care or urology). Although decreased PSA screening occurred across all specialties over time, the greatest reductions in such testing were seen among urologists, among patients in the intermediate age group (aged 50 to 59 years), and at an urban teaching hospital.