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The rate of routine prostate-specific antigen screening among men aged 50 years and older declined 18% during the first year after the 2012 U.S. Preventive Services Task Force recommendation against it, according to two separate reports published online Nov. 17 in JAMA.
Alternative explanations for the substantial decrease in screening rates between 2011 and 2013 are unlikely. Similar changes occurred following new screening recommendations for other cancers, said Dr. Ahmedin Jemal of Surveillance and Health Services Research, American Cancer Society, Atlanta, and his associates.
They assessed temporal trends in both self-reported PSA screening and prostate cancer incidence using nationally representative data on 446,009 men from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and National Health Interview Surveys from 2005 through 2013, the most recent year for which complete data are available.
Routine PSA screening in this age group increased to a high of 40.6% in 2008, the year in which the USPSTF guidelines first questioned the benefit-to-harm ratio of this clinical practice. The screening rate then showed a nonsignificant decrease to 37.8% in 2010, then a significant drop to 30.8% in 2013. That decline represents a relative decrease of 18% in routine PSA screening across all races and age groups in 2013, Dr. Jemal and his associates noted (JAMA. 2015 Nov 17;314[19]:2054-61).
At the same time, 33,519 fewer men across the country received a diagnosis of prostate cancer in 2012 than in 2011.
“On one hand, overdiagnosis and overtreatment may be reduced in view of the substantial proportion of prostate cancer cases detected through PSA testing that would not cause harm if left undetected,” the study authors noted. “On the other hand, less screening ... may lead to missed opportunities for detecting biologically important lesions at an early stage and preventing deaths from prostate cancer, the ultimate goal of screening.”
Given prostate cancer’s slow progression and long natural history, “any increase in mortality may not be seen for several years after the discontinuation of screening,” the investigators added. “Future studies should examine temporal trends in advanced-stage diagnoses and prostate cancer mortality to assess the long-term effects of changes in PSA-based screening practices at the population level.”
In a separate report, investigators analyzed PSA screening data from 20,757 men participating in National Health Interview Surveys from 2000 through 2013 and reported their findings in a research letter to the editor.
Like Dr. Jemal’s research group, Dr. Jesse D. Sammon of Brigham and Women’s Hospital, Boston, and his associates found that routine PSA screening among men aged 50 years and older was approximately 34% in the early 2000s and approximately 36% in 2010. After the USPSTF recommended against routine PSA screening in 2012, such screening declined to approximately 30%.
In a further analysis of the data, compared with 2010, survey year 2013 was associated with a significantly lower likelihood of PSA screening (odds ratio, 0.79).
The decrease occurred primarily among men younger than 75 years. Routine PSA screening declined from 23% to 18% (OR, 0.71) among men aged 50-54 years, and from 45% to 35% (OR, 0.69) among men aged 60-64 years (JAMA. 2015 Nov 17;314[19]:2077-9).
The findings “suggest that younger men may be altering health care behavior at a higher rate than older men following the new USPSTF recommendations, changes in clinician PSA practices, or both,” Dr. Sammon and his associates said.
Dr. Jemal’s study was supported by the American Cancer Society. Dr. Jemal and his associates reported having no financial disclosures. Dr. Sammon’s study was supported by the Vattikuti Urology Institute and the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at Brigham and Women’s Hospital. Dr. Sammon and his associates reported having no financial disclosures.
The decline in routine PSA screening documented by Jemal et al. and Sammon et al., and especially the accompanying decline in prostate cancer incidence, has both pros and cons.
On the positive side, physicians have been overly aggressive during the past 20 years in their approach to prostate cancer. There is no doubt that without this reduction in screening, many men with indolent disease would have been exposed to considerable adverse effects such as sexual, urinary, and bowel problems, with little or no survival benefit.
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Dr. David F. Penson |
But on the negative side, given that 33,519 fewer cases of prostate cancer were diagnosed after the 2013 drop-off in PSA screening, we can estimate that approximately 1,241 more men will die of prostate cancer because they were not diagnosed early. It is essential to acknowledge that these figures are only rough approximations, but they still indicate the potential for excess mortality.
Death from prostate cancer occurs long after diagnosis, with an estimated lead time associated with PSA screening of at least 5-7 years. So, any rise in prostate-cancer mortality related to this 2013 decrease in PSA screening won’t be detected until 2022 or later.
Dr. David F. Penson is in the department of urologic surgery at Vanderbilt University and at the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, both in Nashville. He reported having no financial disclosures. Dr. Penson made these remarks in an editorial accompanying the two reports on the decline in prostate cancer screening (JAMA. 2015 Nov 17;314[19]:2031-3).
The decline in routine PSA screening documented by Jemal et al. and Sammon et al., and especially the accompanying decline in prostate cancer incidence, has both pros and cons.
On the positive side, physicians have been overly aggressive during the past 20 years in their approach to prostate cancer. There is no doubt that without this reduction in screening, many men with indolent disease would have been exposed to considerable adverse effects such as sexual, urinary, and bowel problems, with little or no survival benefit.
|
Dr. David F. Penson |
But on the negative side, given that 33,519 fewer cases of prostate cancer were diagnosed after the 2013 drop-off in PSA screening, we can estimate that approximately 1,241 more men will die of prostate cancer because they were not diagnosed early. It is essential to acknowledge that these figures are only rough approximations, but they still indicate the potential for excess mortality.
Death from prostate cancer occurs long after diagnosis, with an estimated lead time associated with PSA screening of at least 5-7 years. So, any rise in prostate-cancer mortality related to this 2013 decrease in PSA screening won’t be detected until 2022 or later.
Dr. David F. Penson is in the department of urologic surgery at Vanderbilt University and at the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, both in Nashville. He reported having no financial disclosures. Dr. Penson made these remarks in an editorial accompanying the two reports on the decline in prostate cancer screening (JAMA. 2015 Nov 17;314[19]:2031-3).
The decline in routine PSA screening documented by Jemal et al. and Sammon et al., and especially the accompanying decline in prostate cancer incidence, has both pros and cons.
On the positive side, physicians have been overly aggressive during the past 20 years in their approach to prostate cancer. There is no doubt that without this reduction in screening, many men with indolent disease would have been exposed to considerable adverse effects such as sexual, urinary, and bowel problems, with little or no survival benefit.
|
Dr. David F. Penson |
But on the negative side, given that 33,519 fewer cases of prostate cancer were diagnosed after the 2013 drop-off in PSA screening, we can estimate that approximately 1,241 more men will die of prostate cancer because they were not diagnosed early. It is essential to acknowledge that these figures are only rough approximations, but they still indicate the potential for excess mortality.
Death from prostate cancer occurs long after diagnosis, with an estimated lead time associated with PSA screening of at least 5-7 years. So, any rise in prostate-cancer mortality related to this 2013 decrease in PSA screening won’t be detected until 2022 or later.
Dr. David F. Penson is in the department of urologic surgery at Vanderbilt University and at the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, both in Nashville. He reported having no financial disclosures. Dr. Penson made these remarks in an editorial accompanying the two reports on the decline in prostate cancer screening (JAMA. 2015 Nov 17;314[19]:2031-3).
The rate of routine prostate-specific antigen screening among men aged 50 years and older declined 18% during the first year after the 2012 U.S. Preventive Services Task Force recommendation against it, according to two separate reports published online Nov. 17 in JAMA.
Alternative explanations for the substantial decrease in screening rates between 2011 and 2013 are unlikely. Similar changes occurred following new screening recommendations for other cancers, said Dr. Ahmedin Jemal of Surveillance and Health Services Research, American Cancer Society, Atlanta, and his associates.
They assessed temporal trends in both self-reported PSA screening and prostate cancer incidence using nationally representative data on 446,009 men from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and National Health Interview Surveys from 2005 through 2013, the most recent year for which complete data are available.
Routine PSA screening in this age group increased to a high of 40.6% in 2008, the year in which the USPSTF guidelines first questioned the benefit-to-harm ratio of this clinical practice. The screening rate then showed a nonsignificant decrease to 37.8% in 2010, then a significant drop to 30.8% in 2013. That decline represents a relative decrease of 18% in routine PSA screening across all races and age groups in 2013, Dr. Jemal and his associates noted (JAMA. 2015 Nov 17;314[19]:2054-61).
At the same time, 33,519 fewer men across the country received a diagnosis of prostate cancer in 2012 than in 2011.
“On one hand, overdiagnosis and overtreatment may be reduced in view of the substantial proportion of prostate cancer cases detected through PSA testing that would not cause harm if left undetected,” the study authors noted. “On the other hand, less screening ... may lead to missed opportunities for detecting biologically important lesions at an early stage and preventing deaths from prostate cancer, the ultimate goal of screening.”
Given prostate cancer’s slow progression and long natural history, “any increase in mortality may not be seen for several years after the discontinuation of screening,” the investigators added. “Future studies should examine temporal trends in advanced-stage diagnoses and prostate cancer mortality to assess the long-term effects of changes in PSA-based screening practices at the population level.”
In a separate report, investigators analyzed PSA screening data from 20,757 men participating in National Health Interview Surveys from 2000 through 2013 and reported their findings in a research letter to the editor.
Like Dr. Jemal’s research group, Dr. Jesse D. Sammon of Brigham and Women’s Hospital, Boston, and his associates found that routine PSA screening among men aged 50 years and older was approximately 34% in the early 2000s and approximately 36% in 2010. After the USPSTF recommended against routine PSA screening in 2012, such screening declined to approximately 30%.
In a further analysis of the data, compared with 2010, survey year 2013 was associated with a significantly lower likelihood of PSA screening (odds ratio, 0.79).
The decrease occurred primarily among men younger than 75 years. Routine PSA screening declined from 23% to 18% (OR, 0.71) among men aged 50-54 years, and from 45% to 35% (OR, 0.69) among men aged 60-64 years (JAMA. 2015 Nov 17;314[19]:2077-9).
The findings “suggest that younger men may be altering health care behavior at a higher rate than older men following the new USPSTF recommendations, changes in clinician PSA practices, or both,” Dr. Sammon and his associates said.
Dr. Jemal’s study was supported by the American Cancer Society. Dr. Jemal and his associates reported having no financial disclosures. Dr. Sammon’s study was supported by the Vattikuti Urology Institute and the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at Brigham and Women’s Hospital. Dr. Sammon and his associates reported having no financial disclosures.
The rate of routine prostate-specific antigen screening among men aged 50 years and older declined 18% during the first year after the 2012 U.S. Preventive Services Task Force recommendation against it, according to two separate reports published online Nov. 17 in JAMA.
Alternative explanations for the substantial decrease in screening rates between 2011 and 2013 are unlikely. Similar changes occurred following new screening recommendations for other cancers, said Dr. Ahmedin Jemal of Surveillance and Health Services Research, American Cancer Society, Atlanta, and his associates.
They assessed temporal trends in both self-reported PSA screening and prostate cancer incidence using nationally representative data on 446,009 men from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and National Health Interview Surveys from 2005 through 2013, the most recent year for which complete data are available.
Routine PSA screening in this age group increased to a high of 40.6% in 2008, the year in which the USPSTF guidelines first questioned the benefit-to-harm ratio of this clinical practice. The screening rate then showed a nonsignificant decrease to 37.8% in 2010, then a significant drop to 30.8% in 2013. That decline represents a relative decrease of 18% in routine PSA screening across all races and age groups in 2013, Dr. Jemal and his associates noted (JAMA. 2015 Nov 17;314[19]:2054-61).
At the same time, 33,519 fewer men across the country received a diagnosis of prostate cancer in 2012 than in 2011.
“On one hand, overdiagnosis and overtreatment may be reduced in view of the substantial proportion of prostate cancer cases detected through PSA testing that would not cause harm if left undetected,” the study authors noted. “On the other hand, less screening ... may lead to missed opportunities for detecting biologically important lesions at an early stage and preventing deaths from prostate cancer, the ultimate goal of screening.”
Given prostate cancer’s slow progression and long natural history, “any increase in mortality may not be seen for several years after the discontinuation of screening,” the investigators added. “Future studies should examine temporal trends in advanced-stage diagnoses and prostate cancer mortality to assess the long-term effects of changes in PSA-based screening practices at the population level.”
In a separate report, investigators analyzed PSA screening data from 20,757 men participating in National Health Interview Surveys from 2000 through 2013 and reported their findings in a research letter to the editor.
Like Dr. Jemal’s research group, Dr. Jesse D. Sammon of Brigham and Women’s Hospital, Boston, and his associates found that routine PSA screening among men aged 50 years and older was approximately 34% in the early 2000s and approximately 36% in 2010. After the USPSTF recommended against routine PSA screening in 2012, such screening declined to approximately 30%.
In a further analysis of the data, compared with 2010, survey year 2013 was associated with a significantly lower likelihood of PSA screening (odds ratio, 0.79).
The decrease occurred primarily among men younger than 75 years. Routine PSA screening declined from 23% to 18% (OR, 0.71) among men aged 50-54 years, and from 45% to 35% (OR, 0.69) among men aged 60-64 years (JAMA. 2015 Nov 17;314[19]:2077-9).
The findings “suggest that younger men may be altering health care behavior at a higher rate than older men following the new USPSTF recommendations, changes in clinician PSA practices, or both,” Dr. Sammon and his associates said.
Dr. Jemal’s study was supported by the American Cancer Society. Dr. Jemal and his associates reported having no financial disclosures. Dr. Sammon’s study was supported by the Vattikuti Urology Institute and the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at Brigham and Women’s Hospital. Dr. Sammon and his associates reported having no financial disclosures.
FROM JAMA
Key clinical point: Routine prostate-specific antigen screening declined 18% after the USPSTF recommended against it.
Major finding: The decline in routine PSA screening to 30.8% of all men 50 years and older in 2013 represents a relative decrease of 18% across all races and age groups.
Data source: Two separate studies of temporal patterns in prostate cancer screening using nationally representative SEER data for 446,009 men and NHIS data for 20,757 men.
Disclosures: The American Cancer Society funded Dr. Jemal’s study. Dr. Jemal and his associates reported having no disclosures. Vattikuti Urology Institute and the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at Brigham and Women’s Hospital funded Dr. Sammon’s study. Dr. Sammon and his associates reported having no disclosures.
