National Prostate Cancer Screening Rates After the 2012 US Preventive Services Task Force Recommendation Discouraging Prostate-Specific Antigen–Based Screening

2015 ◽  
Vol 33 (22) ◽  
pp. 2416-2423 ◽  
Author(s):  
Michael W. Drazer ◽  
Dezheng Huo ◽  
Scott E. Eggener
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Prostate Specific Antigen ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Significant Proportion ◽  
Preventive Services ◽  
Population Based

Purpose In 2012, the US Preventive Services Task Force (USPSTF) discouraged prostate-specific antigen (PSA) –based prostate cancer screening. Previous USPSTF recommendations did not appreciably alter prostate cancer screening. Therefore, we designed a trend analysis to determine the population-based impact of the 2012 recommendation. Methods The nationally representative National Health Interview Survey was used to estimate the proportion of men age 40 years and older who saw a physician and were screened for prostate cancer in 2013. An externally validated 9-year mortality index was used to analyze screening rates based on remaining life expectancy. Screening rates from 2005, 2010, and 2013 were compared using logistic regression. Results PSA-based screening did not significantly change from 2010 to 2013 among 40- to 49-year-old men (from 12.5% to 11.2%; P = .4). Screening rates significantly declined in men age 50 to 59 years (from 33.2% to 24.8%; P < .01), age 60 to 74 years (from 51.2% to 43.6%; P < .01), and age 75 years or older (from 43.9% to 37.1%; P = .03). A large percentage of men were screened for prostate cancer despite a high risk (> 52%) of 9-year mortality, including approximately one third of men older than age 75 years. Approximately 1.4 million men age 65 years or older with a high risk (> 52%) of 9-year mortality were screened in 2013. Conclusion Prostate cancer screening significantly declined among men older than age 50 years after the 2012 USPSTF guideline discouraging PSA-based screening. A significant proportion of men continue to be screened despite a high risk of 9-year mortality, including one third of men age 75 years and older.

Screening for Prostate Cancer with Prostate-Specific Antigen: What's the Evidence?

2012 ◽  
pp. 96-100 ◽  
Author(s):  
Pamela M. Marcus ◽  
Barnett S. Kramer
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Randomized Study ◽  
Specific Antigen ◽  
Preventive Services ◽  
Preventive Health Care ◽  
Ovarian Cancer Screening

Overview: In October 2011, the U.S. Preventive Services Task Force (USPSTF, or “Task Force”) released draft recommendations on prostate cancer screening with prostate-specific antigen (PSA), concluding that “PSA-based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.” This statement was accompanied by a grade “D” recommendation, which indicates that in the Task Force's judgment there “is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The Task Force, an independent panel of nonfederal (U.S.) experts in prevention and evidence-based medicine, conducts systematic evidence reviews of preventive health care services and makes recommendations about preventive services in primary care. Task Force recommendations do not set U.S. federal policy but can and do influence reimbursement and clinical practice. In this article, we will present evidence the Task Force considered when making its decision, including two highly influential randomized controlled trials (RCTs) of prostate cancer screening, the European Randomized Study of Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The two trials arrived at different conclusions about the efficacy of routine prostate cancer screening, but similar conclusions about the accompaniment of clinically relevant harms with prostate cancer screening, including overdiagnosis (screen detection of cancers that never would be diagnosed in the absence of screening). We also will present other available evidence on benefits and harms of PSA-based screening and consider that evidence and the findings of ERSPC and PLCO in conjunction with one another.

Randomised Trial of Prostate Cancer Screening in the Netherlands: Assessment of Acceptance and Motives for Attendance

1997 ◽  
Vol 4 (2) ◽  
pp. 102-106 ◽  
Author(s):  
H G T Nijs ◽  
D M R Tordoir ◽  
J H Schuurman ◽  
W J Kirkels ◽  
F H Schroder
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Population Based ◽  
Personal Benefit ◽  
Screening Procedures

Abstract Objectives— To assess motives for attending a randomised population based prostate cancer screening trial, and to assess acceptance of screening and invitation procedures. Methods— First pilot of the European Randomised Study of Screening for Prostate Cancer (ERSPC; 1992/1993). Men aged 55–75 years, randomly selected from the population register of four city districts of Rotterdam, were invited by a single invitation for screening. Screening consisted of prostate specific antigen prescreening followed by either (1) digital rectal examination, transrectal ultrasound, and, on indication, biopsy, or (2) no additional screening. After screening, or in the case of non-attendance, a questionnaire was sent to a random sample of 600 attenders and 400 non-attenders, with a reminder after three weeks. Outcome measures— In both attenders and non-attenders: Knowledge of prostate cancer, attitudes towards screening, motives for attending, procedural aspects and sociodemographic characteristics. In attenders, acceptance of screening procedures. Results— The response rate for the questionnaire was 76%: 94% in attenders and 42% in non-attenders. The main reasons for attending were expected personal benefit (76%) and scientific value (39%), and those for not attending were the absence of urological complaints (41%) and anticipated pain or discomfort (24%). Uptake of screening was 32%, which increased to a sustained 42% in following years. Attenders, compared with non-attenders, were significantly younger, more often married, better educated, and had higher perceived health status, more knowledge about prostate cancer, and a more positive attitude towards screening. Information materials and invitation procedure were adequate. Screening procedures were well accepted (high report marks and satisfaction, and 95% would attend for rescreening). A single prostate specific antigen determination was liked less than a combination of all three screening modalities. Conclusions— (1) The main reasons for attending are personal benefit and science, and those for not attending were absence of urological complaints and anticipated pain or discomfort; (2) knowledge, attitudes, and motives for attending are comparable with other screening programmes; hence, for population based prostate cancer screening, known health promotional aspects should be carefully considered; (3) prostate specific antigen, digital rectal examination and transrectal ultrasound are acceptable to attenders.

scholarly journals Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians’ opinions and practices

2017 ◽  
Vol 11 (12) ◽  
pp. 396-403 ◽  
Author(s):  
Mitchell Geoffrey Goldenberg ◽  
Sean C. Skeldon ◽  
Madhur Nayan ◽  
Yegappan Suppiah ◽  
Linda Chow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
National Survey ◽  
Primary Care Physicians ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Screening

Introduction: In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test.1 We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016.Methods: Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening.Results: A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55‒69 years old should not be screened for prostate cancer with PSA.Conclusions: Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.

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