This study describes longitudinal trends in the use of prostate-specific antigen (PSA)-based testing in two geographically distinct healthcare systems following the 2011 US Preventive Services Task Force (USPSTF) recommendations against routine PSA screening.
We analyzed population-based health claims data from 253,139 men aged 40–80 who were enrolled at two US healthcare systems. We assessed trends in the percentage of eligible men receiving ≥ 1 PSA test per year by time period (2000–2008, 2009–2011, 2012–2014), age (40–54, 55–69, 70–80), and race (white, black, other, unknown), and conducted a joinpoint regression analysis.
Men aged 55–69 and 70–80 years of all races had similar use of PSA testing between 2000 and 2011, ranging between 47 and 56% of eligible men by year, while only 22–26% of men aged 40–54 had a PSA test per year during this period. Overall, the percentage of men receiving at least one PSA test per year decreased by 26% between 2009–2011 and 2012–2014, with similar trends across race and age groups. PSA testing declined significantly after 2011 (annual percent change = − 11.28).
Following the 2011 USPSTF recommendations against routine PSA screening, declines in PSA testing were observed among men of all races and across all age groups in two large US healthcare systems.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Moyer VA, US Preventive Services Task Force (2012) Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 157(2):120–134. https://doi.org/10.7326/0003-4819-157-2-201207170-00459
Miller A, Yates J, Epstein MM et al (2017) Impact of 2012 USPSTF screening PSA guideline statement: changes in primary care provider practice patterns and attitudes. Urol Pract 4(2):126–131
Rosenberg M, Crawford ED, Newmark J, Steiner M (2016) Use of PSA sceening guidelines among primary care physicians [abstract]. J Urol. 195(4):Se541
Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P, Clinical Guidelines Committee of the American College of Physicians (2013) Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 158(10):761–769. https://doi.org/10.7326/0003-4819-158-10-201305210-00633
Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, Holmberg L, Kantoff P, Konety BR, Murad MH, Penson DF, Zietman AL (2013) Early detection of prostate cancer: AUA guideline. J Urol 190(2):419–426. https://doi.org/10.1016/j.juro.2013.04.119
Mohler J, Bahnson RR, Boston B, Busby JE, D'Amico A, Eastham JA, Enke CA, George D, Horwitz EM, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Macvicar G, Plimack ER, Pow-Sang JM, Roach M 3rd, Rohren E, Roth BJ, Shrieve DC, Smith MR, Srinivas S, Twardowski P, Walsh PC (2010) NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw 8(2):162–200
Cuzick J, Thorat MA, Andriole G, Brawley OW, Brown PH, Culig Z, Eeles RA, Ford LG, Hamdy FC, Holmberg L, Ilic D, Key TJ, La Vecchia C, Lilja H, Marberger M, Meyskens FL, Minasian LM, Parker C, Parnes HL, Perner S, Rittenhouse H, Schalken J, Schmid HP, Schmitz-Drager BJ, Schroder FH, Stenzl A, Tombal B, Wilt TJ, Wolk A (2014) Prevention and early detection of prostate cancer. Lancet Oncol 15(11):e484–492. https://doi.org/10.1016/S1470-2045(14)70211-6
Merrill RM, Sloan A (2012) Risk-adjusted incidence rates for prostate cancer in the United States. Prostate 72(2):181–185. https://doi.org/10.1002/pros.21419
Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J (2018) Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force. JAMA 319(18):1914–1931. https://doi.org/10.1001/jama.2018.3712
US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, Doubeni CA, Ebell M, Epling JW, Jr., Kemper AR, Krist AH, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Siu AL, Tseng CW (2018) Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 319(18):1901–1913. https://doi.org/10.1001/jama.2018.3710
Jemal A, Fedewa SA, Ma J, Siegel R, Lin CC, Brawley O, Ward EM (2015) Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 314(19):2054–2061. https://doi.org/10.1001/jama.2015.14905
Jemal A, Ma J, Siegel R, Fedewa S, Brawley O, Ward EM (2016) Prostate cancer incidence rates 2 years after the US preventive services task force recommendations against screening. JAMA Oncol 2(12):1657–1660. https://doi.org/10.1001/jamaoncol.2016.2667
Sammon JD, Abdollah F, Choueiri TK, Kantoff PW, Nguyen PL, Menon M, Trinh QD (2015) Prostate-specific antigen screening after 2012 US preventive services task force recommendations. JAMA 314(19):2077–2079. https://doi.org/10.1001/jama.2015.7273
Fleshner K, Carlsson SV, Roobol MJ (2017) The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 14(1):26–37. https://doi.org/10.1038/nrurol.2016.251
Misra-Hebert AD, Hu B, Klein EA, Stephenson A, Taksler GB, Kattan MW, Rothberg MB (2017) Prostate cancer screening practices in a large, integrated health system: 2007–2014. BJU Int 120(2):257–264. https://doi.org/10.1111/bju.13793
Wagner EH, Greene SM, Hart G, Field TS, Fletcher S, Geiger AM, Herrinton LJ, Hornbrook MC, Johnson CC, Mouchawar J, Rolnick SJ, Stevens VJ, Taplin SH, Tolsma D, Vogt TM (2005) Building a research consortium of large health systems: the Cancer Research Network. J Natl Cancer Inst Monogr 35:3–11. https://doi.org/10.1093/jncimonographs/lgi032
Field TS, Cernieux J, Buist D, Geiger A, Lamerato L, Hart G, Bachman D, Krajenta R, Greene S, Hornbrook MC, Ansell G, Herrinton L, Reed G (2004) Retention of enrollees following a cancer diagnosis within health maintenance organizations in the Cancer Research Network. J Natl Cancer Inst 96(2):148–152
Ross TR, Ng D, Brown JS, Pardee R, Hornbrook MC, Hart G, Steiner JF (2014) The HMO research network virtual data warehouse: a public data model to support collaboration. EGEMS (Wash DC) 2(1):1049. https://doi.org/10.13063/2327-9214.1049
Joinpoint Regression Program, Version 22.214.171.124 (2018) Statistical methodology and applications branch, Surveillance Research Program, National Cancer Institute
Scosyrev E, Wu G, Golijanin D, Messing E (2012) Prostate-specific antigen testing in older men in the USA: data from the behavioral risk factor surveillance system. BJU Int 110(10):1485–1490. https://doi.org/10.1111/j.1464-410X.2012.11013.x
Shoag J, Halpern JA, Lee DJ, Mittal S, Ballman KV, Barbieri CE, Hu JC (2016) Decline in prostate cancer screening by primary care physicians: an analysis of trends in the use of digital rectal examination and prostate specific antigen testing. J Urol 196(4):1047–1052. https://doi.org/10.1016/j.juro.2016.03.171
Daskivich TJ, Chamie K, Kwan L, Labo J, Dash A, Greenfield S, Litwin MS (2011) Comorbidity and competing risks for mortality in men with prostate cancer. Cancer 117(20):4642–4650. https://doi.org/10.1002/cncr.26104
Zanwar P, Lin YL, Kuo YF, Goodwin JS (2016) Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study. BMC Health Serv Res 16:17. https://doi.org/10.1186/s12913-016-1265-1
Chubak J, Ziebell R, Greenlee RT, Honda S, Hornbrook MC, Epstein M, Nekhlyudov L, Pawloski PA, Ritzwoller DP, Ghai NR, Feigelson HS, Clancy HA, Doria-Rose VP, Kushi LH (2016) The Cancer Research Network: a platform for epidemiologic and health services research on cancer prevention, care, and outcomes in large, stable populations. Cancer Causes Control 27(11):1315–1323. https://doi.org/10.1007/s10552-016-0808-4
DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, Jemal A (2016) Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin 66(4):290–308. https://doi.org/10.3322/caac.21340
This work was supported by a 2015 American Urological Association Data Grant to MHS. MME was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR001454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of interest
The authors declare that they have no conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Frendl, D.M., Epstein, M.M., Fouayzi, H. et al. Prostate-specific antigen testing after the US Preventive Services Task Force recommendation: a population-based analysis of electronic health data. Cancer Causes Control 31, 861–867 (2020). https://doi.org/10.1007/s10552-020-01324-x
- Prostate-specific antigen
- Prostate cancer
- Healthcare claims