Older Men Continue To Have PSA Screening Despite Benefits Unlikely To Outweigh Risks

MedicalResearch.com Interview with:
Zahava Berkowitz, MSPH, MSc
Statistician
Division of Cancer Prevention and Control
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study?

Response: The US Preventive Services Task Force 2017 draft prostate cancer screening recommendations  suggest that clinicians inform men aged 55–69 years about the potential benefits and harms of PSA-based screening for prostate cancer.

The CDC conducted an analysis using the National Health Interview Surveys in 2005, 2008, 2010, 2013, and 2015 to describe trends in the receipt of routine PSA testing in the past year by age group (40–54, 55–69, ≥70 years) and by risk group. We compared routine PSA screening among higher risk men (defined as African American men or men with a family history of prostate cancer) with other men. The analysis was conducted because CDC wanted to examine how the guidelines affect men at higher risk. The 2017 guideline did not include specific guidelines for African American men who have a higher incidence of prostate cancer than white men, more likely to develop prostate cancer at a young age, more likely to have a high-risk diagnosis and die from prostate cancer.

MedicalResearch.com: What are the main findings?

  • PSA testing among men aged 55–69 years decreased from a high of 43.1% in 2008 to a low of 32.8% in 2013, with no significant change in 2015 at 33.8%. Although there was a decrease over time, the absolute change in PSA testing for men aged 55–69 years was relatively small (9.3%) over the study period.  Despite recommendations for decision making and decrease in PSA testing, it is not clear what recommendations are being commonly followed in practice, and how patient values and preferences, and Medicare reimbursement for PSA screening, might contribute to the observed patterns.
  • Men aged ≥70 years, where the benefits are unlikely to exceed the harms, continue to show a high testing prevalence in all survey years, ranging from 51.1% in 2008 to 36.4% in 2015.
  • Men at higher risk showed a 5% absolute decrease over time, but this was not a statistically significant decrease.

MedicalResearch.com: What should readers take away from your report?

  • Surveillance of current trends in PSA testing among men is useful as part of efforts to plan interventions to refine prostate cancer screening and increase the use of shared decision making before testing.  We found that men aged ≥70 years consistently had a high prevalence of screening (36.4% in 2015). The benefits of screening for this age group are unlikely to exceed the harms. Our study points to the need for understanding the causes of the high frequency of testing and to help develop interventions that emphasize discussions between providers and their patients before prostate cancer screening.
  • Men at higher risk, who have been underrepresented in most prostate cancer screening research, would benefit from larger representation in future studies, and possibly from additional screening guidelines.
  • Physicians should inform men about the implications of screening decisions and help them make a decision based on their values and preferences.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: More research is needed in two areas, first to better understand the factors that contribute to the relatively high testing prevalence among men aged ≥70 years, where the benefits are unlikely to exceed the harms.

In addition, studies are needed to determine the effect of changes in PSA screening recommendations on detection and the balance of potential benefits versus harms due to over-diagnosis and complications from treatment. 

MedicalResearch.com: Is there anything else you would like to add?

Response: There is a need for more professional and public awareness activities to help men get the most effective tools for understanding how to engage with their health care providers in making decisions about prostate cancer screening. The tools to support men include receiving culturally appropriate information about the uncertainties, the harms, and the potential benefits associated with prostate cancer screening. Men should not undergo prostate cancer screening without an informed decision-making process.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Berkowitz, Zahava & Li, Jun & B. Richards, Thomas & M. Marcus, Pamela. (2017). Patterns of Prostate-Specific Antigen Test Use in the U.S., 2005–2015. American Journal of Preventive Medicine. . 10.1016/j.amepre.2017.08.003.

http://www.ajpmonline.org/article/S0749-3797(17)30438-5/abstract

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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