Prostate Specific Antigen Screening Declines After 2012 USPSTF Recommendations

Greatest Decrease Observed Among Urologists, Reports The Journal Of Urology®

New York, NY, March 13, 2014

Researchers at Case Western Reserve University and University Hospitals Case Medical Center have assessed the impact of the 2012 U.S. Preventive Services Task Force (USPSTF) recommendations against routine prostate specific antigen (PSA) cancer screenings, which cited evidence that the risks of screening outweigh the benefits. Results of the current study indicate that the USPSTF recommendations have resulted in a decrease in the number of PSA screenings ordered by doctors, with the greatest decline seen among urologists. The findings are published in the June issue of The Journal of Urology®.

PSA screening has not been without controversy. While early detection is the key to treating prostate cancer, routine PSA screenings have come under scrutiny because of potential over diagnosis and overtreatment of “clinically insignificant” prostate cancer.

In the current study, investigators looked at data for PSA tests performed at University Hospitals Case Medical Center and its affiliated facilities from January 2008 to December 2012. During that period, 43,498 PSA screenings were performed, with the majority of the tests ordered by internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%). Screening numbers started to decline in 2009 with the release of the initial PSA screening trial results, and then continued to decline after the USPSTF recommendations were issued.

To explore the specifics of the decline, investigators evaluated data reported for type of medical provider ordering the tests, as well as geographic location of the facility. “The recently published prostate screening trials and the USPSTF recommendations appear to have negatively impacted PSA screening,” says lead investigator Dr. Robert Abouassaly, MD, MSc, Assistant Professor of Urology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center. “These effects were more immediate and pronounced in the urban/academic setting, and more gradual in suburban and rural settings. Decreased prostate cancer screening was observed across all specialties over time, with, interestingly, the greatest impact seen among urologists.”

The researchers explain that because for urologists, prostate cancer is a focal point of their day-to-day practice, the changes in PSA screening behavior may have been more rapidly acknowledged. Primary care physician offices manage a broad range of medical topics with varied screening policies and thus there may be a delay in the implementation of new policies. Also, PSA screening policy may not quickly circulate through rural and suburban areas compared to urban/academic practices.

While there is a perceived benefit by some doctors and patients for routine PSA screening, for most men who have an average risk of prostate cancer, an early diagnosis and subsequent aggressive treatment may lead to decreased quality of life. Currently the medical community remains divided on the merits of PSA testing for everyone. “Clinical practice guidelines for prostate cancer screening vary and are controversial due to uncertainty as to whether the benefits of screening ultimately outweigh the risks of over diagnosis and overtreatment,” concludes Dr. Abouassaly. “Further study will be needed to determine the long-term effects of these recommendations on screening, diagnosis, treatment, and prognosis of this prevalent malignancy.”

---


Notes for editors
“The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System,” by Afshin Aslani, MD, MPH; Brian J. Minnillo, MD; Ben Johnson, MD; Edward E. Cherullo, MD; Lee E. Ponsky, MD; and Robert Abouassaly, MD, MSc. DOI: 10.1016/j.juro.2013.12.010. The Journal of Urology, Volume 191, Issue 6 (June 2014) published online in advance of issue by Elsevier.

Full text of the article is available to credentialed journalists upon request; contact Linda Gruner at +1 212 633 3923 or jumedia@elsevier.com to obtain copies. To schedule an interview with the authors contact George Stamatis, Sr. Media Relations Strategist, University Hospitals Case Medical Center, at +1 216 844 3667; +1 216 570 4719 or george.stamatis@uhhospitals.org.

About the authors
Afshin Aslani, MD, MPH, Postdoctoral Research Fellow, Case Western Reserve University School of Medicine
Brian J. Minnillo, MD, Resident in Urology, University Hospitals Case Medical Center
Ben Johnson, MD, Clinical Fellow in Oncology at University Hospitals Case Medical Center
Edward E. Cherullo, MD, Program Director for Urology at University Hospitals Case Medical Center; Associate Professor of Urology at Case Western Reserve University School of Medicine; and Vice Chair of Clinical Operations for the Urology Institute at University Hospitals
Lee E. Ponsky, MD, Associate Professor of Urology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center
Robert Abouassaly, MD, MSc, Assistant Professor of Urology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center

About The Journal of Urology®
Established in 1917, The Journal of Urology is the official journal of the American Urological Association. It is the most widely read and highly cited journal in the field. It brings to its readership all the clinically relevant information needed to stay at the forefront of this dynamic field. This top-ranking journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide and practice-oriented reports on interesting clinical observations.

About Elsevier

Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligence,and ClinicalKey—and publishes over 2,200 journals, including The Lancet and Cell, and over 25,000 book titles, including a number of iconic reference works.

The company is part of Reed Elsevier Group PLC, a world leading provider of professional information solutions in the Science, Medical, Legal and Risk and Business sectors, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Media contact
Linda Gruner
Elsevier
+1 212 633 3923
jumedia@elsevier.com