Prostate cancer screening fell in wake of trial results, task force recommendations

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.