PSA Testing Increased for Prostate Cancer Following Revised National Guidelines from 2017 by US Preventive Services Task Force

Prostate-specific antigen (PSA) testing rates increased following updated guidelines from the US Preventive Services Task Force (USPSTF) in 2017 which reversed recommendations from 2012 that advised against PSA testing for all men, according to results from a retrospective cohort study published in JAMA Oncology.¹

The mean rate of PSA testing increased from 32.5 tests per 100-person years to 36.5 tests per 100-person years from 2016 to 2019. The growth translated to a relative increase of 12.5% (95% CI, 1.1%-24.4%).

“The findings from our study are intriguing. Increases in PSA testing were expected based on renewed support the consideration of screening from the USPSTF. These findings underscore the importance of screening guidelines from the task force and the rapid responsiveness of clinicians and patients,” lead author Michael S. Leapman, MD, assistant professor of urology and clinical program leader of the Prostate and Urologic Cancers Program at Smilow Cancer Center, and Yale Cancer Center, said in a press release.²

Data were collected for the retrospective study utilizing the Blue Cross Blue Shield (BCBS) Axis, which encompasses 36 health organizations and companies. Time periods were categorized by 42 successive, independent 2-month periods from January 1, 2013, to December 31, 2019, with each period including men aged 40 to 89 years who had continuous health insurance for a minimum 14 months.

At the time of the 2012 guidelines, the recommendations suggested that the harms of PSA testing for men outweighed the benefits. The 2017 guidelines published by the USPSTF reversed these recommendations, suggesting to men aged 55 to 69 years undergo testing and that the decision to undergo periodic PSA-based screening is an individual decision.^3,4

The median number of eligible beneficiaries included in every bimonthly timeframe was 8,087,565 (range, 6,407,602-8,747,308) for each period. The median age for the overall population of beneficiaries was 53 years (IQR, 47-59).

Among individuals aged 55 to 69 years during the 2016 to 2019 period, investigators observed an increase in the overall rate of PSA testing from 49.8 per 100 person-years to 55.8 per 100 person-years (P <.001); this translated to a relative increase of 12.1% in testing. Research identified a significant increase in PSA testing after April 2017 in this age group, reporting 0.31 additional tests per 100 person-years (P = .004).

Outside of the guideline-recommended age categories, PSA testing was also found to have increases. For those aged 40 to 54 years, the mean testing rate increased from 20.6 per 100 person-years to 22.7 per 100 person-years from 2016 to 2017. This translated to a 10.1% relative increase. For those between the ages of 70 to 89 years, investigators reported a mean rate increase from 38.0 per 100 person-years in 2016 to 44.2 per 100 person-years in 2019, which represented a 6.2% absolute increase and a 16.2% (95% CI, 4.2%- 29.0%) relative increase.

A significant change in absolute rate was observed for those aged 70 to 74 years. The mean rate was 50.0 per 100 person-years in 2016, which increased to 58.3 per 100 person-years in 2019; investigators stated that this translated to an absolute increase of 8.2%.

“The consequences of increased PSA testing remain to be appreciated,” senior author Xiaomei Ma, PhD, professor of epidemiology and co-leader of the Cancer Prevention and Control Research Program at Yale Cancer Center, said in a press release. “Further study is needed to better understand patient perspectives and potential quality of life implications for both younger and older men.”

References

1. Leapman MS, Wang R, Park H, et al. Changes in prostate-specific antigen testing relative to the revised US preventive services task force recommendation on prostate cancer screening. JAMA Oncol. Published online November 11, 2021. doi:10.1001/jamaoncol.2021.5143
2. Yale Cancer Center study shows rates of PSA testing for prostate cancer increased after revised national guidelines. News release. Yale School of Medicine. November 11, 2021. Accessed November 12, 2021. https://tinyurl.com/s25w3urk
3. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(11):762-771.
4. Barocas DA, Mallin K, Graves AJ, et al. Effect of the USPSTF grade D recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the United States. J Urol. 2015;194(6):1587-1593. doi:10.1016/j.juro.2015.06.075