PSA screening for prostate cancer drops significantly in middle-aged men

PSA testing has dropped significantly in middle-aged men after a 2012 recommendation that all men should not be routinely screened for prostate cancer, according to a new study published in the Journal of the American Medical Association.

The study, published as a research letter online, focused on the use of PSA - prostate-specific antigen - to screen for prostate cancer.

The study, conducted jointly at the Center for Surgery and the Public Health at Brigham and Women's Hospital (BWH) in Boston and Henry Ford Health System's Vattikuti Urology Institute in Detroit, looked at PSA screening data before and after a 2012 recommendation by the US Preventive Services Task Force (USPSTF). The USPSTF recommended against PSA screening for all men, regardless of age.

"It appears middle-aged men are hearing the message," says the study's lead author, Henry Ford Health System urologist Jesse Sammon, D.O., who also serves as a fellow at BWH. "The problem is they're controversial recommendations and very high quality evidence supports the consideration of PSA screening for many men."

The researchers found the biggest declines were seen in men ages 50-54 years old, from 23% undergoing PSA screening in 2010 to 18% in 2013, and men ages 60-64, from 45% to 35%.

"Decreased screening will most likely lead to fewer prostate cancer diagnoses," says the study's senior author, Quoc-Dien Trinh, M.D., also a urology surgeon at BWH. "Some will think that this is a good thing, as fewer men will be subjected to the harms of overtreatment, while others may be concerned with its potentially catastrophic consequences, with more men presenting with advanced, metastatic prostate cancer. The study findings also suggest that policy statements can have a significant impact on how providers deliver preventive care."

The study also found that men 75 years and older are still not following a 2008 recommendation against screening for older men, with the percentage undergoing screening remaining largely unchanged over the study period.

"Our findings suggest that younger men may be forgoing screening at a higher rate than older men following the 2012 USPSTF recommendations, and this is the population that may benefit most from screening," says Dr. Sammon.

Though credited with a significant improvement in 5-year cancer survival rates during the first decade after the FDA approved PSA testing of men without symptoms, its use for routine screening is controversial.

The test can produce false-positives, leading to unnecessary treatment and the possibility of side effects such as impotence and urinary incontinence.

But many professional organizations, including the American Urologic Association and the American Cancer Society, continue to advocate for various levels of PSA screening, depending on age.

"While the US Preventive Services Task Force does not support the use of screening, other organizations support a more balanced, joint decision-making process between patients and their healthcare providers, particularly in those men ages 55 to 75," says Dr. Sammon.

The researchers examined PSA screening data for 20,757 men from the 2000, 2005, 2010 and 2013 National Health Interview Survey (NHIS), which had an 80% survey response rate.

The findings suggest that the USPSTF's 2012 recommendations could have affected decision making for younger men and/or their doctors. According to the researchers, economic recession or a delayed response to the 2008 recommendations may have also contributed to the study findings.