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Changes in PSA Screening After 2017 USPSTF Guidance Revision


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In a study reported in JAMA Oncology, Michael S. Leapman, MD, and colleagues found that prostate-specific antigen (PSA) screening for prostate cancer has increased since the 2017 publication of the U.S. Preventive Services Task Force (USPSTF) draft guidance endorsing individual decision-making for men aged 55 to 69 years. This guidance reversed the USPSTF’s 2012 guidance advising against routine PSA screening in all men.

As stated by the investigators, “In April 2017, the USPSTF published a draft guideline that reversed prior guidance against routine screening for prostate cancer [grade D recommendation], issuing a grade C recommendation for men aged 55 to 69 years that the decision to undergo periodic PSA-based screening … should be an individual one, based on a discussion of the potential benefits and harms. The updated guideline was published in its final form in May 2018 and continued to emphasize the potential harms of screening and to discourage PSA testing for patients [aged] 70 years or older.”


This large national cohort study found that rates of PSA testing increased after the USPSTF’s draft statement in 2017, reversing trends seen after earlier guidance against PSA testing for all patients. Increased testing was also observed among older men, who may be less likely to benefit from prostate cancer screening.
— Michael S. Leapman, MD

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The retrospective cohort study used de-identified claims data from Blue Cross Blue Shield beneficiaries aged 40 to 89 years from January 2013 through December 2019. Age-adjusted rates of PSA testing in bimonthly periods were calculated, with rates before (January to December 2016) and after (January to December 2019) the change in guidance being compared.

Key Findings

The median number of eligible men for each bimonthly period during the study period was 8,087,565 (range = 6,407,602–8,747,308) and the median age of all eligible men was 53 years (interquartile range = 47–59 years).

Between 2016 and 2019, the mean rate of PSA testing among men aged 40 to 89 years increased from 32.5 (standard deviation [SD] = 1.1) to 36.5 (SD = 1.1) tests per 100 person-years, representing a 4.0% absolute increase (95% confidence interval [CI] = 1.5%–6.6%) and a 12.5% relative increase (95% CI = 1.1%–24.4%). A significant trend in increased testing of 0.30 tests per 100 person-years in each successive bimonthly period (P < .001) was observed after the April 2017 publication of the draft guidance.

According to age group, mean rates of PSA testing per 100 person years increased from:

  • 20.6 (SD = 0.8) to 22.7 (SD = 0.9) among men aged 40 to 54 years (absolute increase = 2.1%, 95% CI = 0.2%–3.9%; relative increase = 10.1%, 95% CI = −2.8% to 23.7%)
  • 49.8 (SD = 1.9) to 55.8 (SD = 1.8) among men aged 55 to 69 years (absolute increase = 6.0%, 95% CI = 1.9%–10.2%; relative increase = 12.1%, 95% CI = −0.2% to 25.2%)
  • 38.0 (SD = 1.4) to 44.2 (SD = 1.4) among men aged 70 to 89 years (absolute increase = 6.2%, 95% CI = 3.1%–9.2%; relative increase = 16.2%, 95% CI = 4.2%–29.0%).

Significant trends in increased testing per 100 person-years in successive bimonthly periods after April 2017 were observed in each age group: 0.15 (P = .006) among men aged 40 to 54 years, 0.31 (P = .004) among those aged 55 to 69 years, and 0.65 (P < .001) among those aged 70 to 89 years.

The investigators concluded, “This large national cohort study found that rates of PSA testing increased after the USPSTF’s draft statement in 2017, reversing trends seen after earlier guidance against PSA testing for all patients. Increased testing was also observed among older men, who may be less likely to benefit from prostate cancer screening.”

Dr. Leapman, of the Department of Urology, Yale University School of Medicine, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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