History shows USPSTF PSA recommendation may have no impact on screening

Curious about how the U.S. Preventive Services Task Force’s recently drafted recommendation against routine PSA screening for prostate cancer at any age would affect clinical practice, investigators at the University of Chicago Medical Center and UCLA studied the effect of a 2008 task force recommendation against screening in men aged 75 years or older and found there was none.

Using data from the 2005 and 2010 Cancer Control Supplements, part of the annual National Health Interview Survey, the study looked at 5,332 men aged 40 years and older who had PSA screening in 2005 and another 4,640 who had screening in 2010. The PSA screening rates were unchanged in all age groups over time. In men aged 75 years or older, PSA screening was nearly unchanged between 2005 (43%) and 2010 (43.9%). In 2010, PSA screening was more common in men aged 75 years or older than in men aged 40 to 49 years (12.5%) and 50 to 59 years (33.2%) but not in men aged 60 to 74 years (51.2%).

"Large population-based studies have demonstrated PSA screening in men aged 75 years or older is inappropriately high given the limited likelihood of benefit," the authors wrote in a research letter published in JAMA (2012; 307:1692-4). "Despite the USPSTF recommendation against prostate cancer screening in men aged 75 years or older in 2008, PSA screening rates did not change."

Even if PSA screening is discouraged in the final USPSTF recommendation, "I’m not anticipating a massive change in utilization," said study co-author Scott Eggener, MD, of the University of Chicago.

"The discrepancy between the USPSTF recommendation and subsequent practice patterns may reflect lack of guideline awareness, financial incentives, or patient or physician confidence in PSA screening," according to the authors. They said clinical practice patterns following the 2011 USPSTF recommendations should be monitored.

Urologist groups have repeatedly criticized the USPSTF draft, most recently when 2 additional years of results from the European Randomized Study of Screening for Prostate Cancer confirmed original findings that screening significantly reduces death from prostate cancer. ERSPC was one of two large studies used by the USPSTF to reach its recommendation against PSA screening. The European findings were already trending away from the task force’s position and many urologists believe that had the USPSTF waited for later findings, it wouldn’t have reached the conclusion it did.

Funding for the study was provided by the Department of Defense and the University of Chicago Medicine.

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