USPSTF PSA grade has ‘minimal’ impact on screening

The effect of the U.S. Preventive Services Task Force’s controversial grade “D” recommendation regarding PSA-based screening for prostate cancer “has been minimal at best,” according to a research letter that also shows a “shocking” level of statewide variance in screening, a leading prostate cancer expert said.

The effect of the U.S. Preventive Services Task Force’s controversial grade “D” recommendation regarding PSA-based screening for prostate cancer “has been minimal at best,” according to a research letter that also shows an “alarming” trend concerning screening in men who need it most, a leading prostate cancer expert said.

The research letter’s authors, writing online in JAMA Internal Medicine (Sept. 1, 2014), found an estimated 17 million men age 50 years or older without a history of prostate cancer or prostate problems who reported undergoing PSA screening. They drew their data from the 2012 Behavioral Risk Factor Surveillance System.

The study group was analyzed according to age, race and/or ethnicity, education, income, residence location, insurance status, access to regular health care, and marital status.

The authors found that higher rates of screening were most strongly associated with access to regular health care, followed by an income greater than $75,000, college education, health insurance, and age 70 to 74 years.

The next highest rate of screening was in men ages 65 to 69 years. Those ages 50 to 54 years were found to be the least likely to report PSA screening.

In addition, an analysis of self-reported PSA screening across the U.S. found the highest rate (59.4%) in Hawaii and the lowest (24.5 %) in New Hampshire.

“Looking at rates of colorectal and breast cancer screening, state-by-state and regional variability is expected, but not to the pronounced extent that we found for PSA screening,” said lead author Jesse D. Sammon, DO, of Henry Ford Health System’s Vattikuti Urology Institute in a press release.

“This was another concerning and surprising study finding. It is alarming that the prevalence of PSA screening can double from one state to the next,” the authors wrote.

The authors said their findings likely reflect “both the considerable disagreement among experts and the conflicting recommendations on PSA screening.

“Taken together, these results suggest that national guidelines have had a limited effect on clinical practice among health care providers,” they concluded.

Next: Dr. Thrasher discusses findings

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Discussing the study with Urology Times, J. Brantley Thrasher, MD, commented that he was not surprised at the authors’ findings regarding associations between age, education, and access to care and likelihood of screening.

“These are the folks most likely to be concerned about multiple health problems, and obviously they can afford to get it checked. This fact has been true in most maladies,” said Dr. Thrasher, of the University of Kansas, Kansas City, and a UT editorial consultant.

“The alarming part of this to me is that the group of men that would benefit most are those 50-59. I would hope that the impact would be greatest in those least likely to benefit-primarily in the elderly and those with significant comorbidities.”

“As far as the state-by-state variance, it isn't surprising that we see some variation based on how liberal or conservative the states are, common retiree state or not, etc. However, the amount of variance was shocking to me,” Dr. Thrasher added.

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