Impact of Updated USPSTF Prostate Cancer Screening Recommendation on Rates of PSA Testing

After a revision to the US Preventative Services Task Force (USPSTF) guideline on prostate cancer screening endorsing individual decision-making regarding prostate-specific antigen (PSA)-based screening, rates of PSA screening increased, according to a study published in JAMA Oncology (2022;8[1]:41-47. doi:10.1001/jamaoncol.2021.5143).

This study used deidentified claims data from Blue Cross Blue Shield beneficiaries aged 40 to 89 years from January 2013 to December 2019. Researchers calculated age-adjusted rates of PSA testing in bimonthly periods and compared rates of PSA testing before (January to December 2016) and after (January to December 2019) the guideline revision.

The association between the draft and published USPSTF guideline with rates of PSA testing were evaluated using interrupted time series analyses. In addition, rates of PSA testing were evaluated among beneficiaries within the age categories reflected in the guideline: 40 to 54 years, 55 to 69 years, and 70 to 89 years.

The median number of eligible beneficiaries for each bimonthly period was 8,087,565. The median age of all included eligible beneficiaries was 53 years.

Between 2016 and 2019, the mean rate of PSA testing increased from 32.5 to 36.5 tests per 100 person-years, a relative increase of 12.5%. In addition, the mean rates of PSA testing increased from 20.6 to 22.7 tests per 100 person-years among men aged 40 to 54 years (relative increase, 10.1%), from 49.8 to 55.8 tests per 100 person-years among men aged 55 to 69 years (relative increase, 12.1%), and from 38 to 44.2 tests per 100 person-years among men aged 70 to 89 years (relative increase, 16.2%).

Results from interrupted time series analysis demonstrated a significant increase in PSA testing after the revision to the USPSTF guideline among all beneficiaries (0.30 tests per 100 person-years for each bimonthly period; P <.001).

“This large national cohort study found that rates of PSA testing increased after the USPSTF’s draft statement in 2017, reversing trends seen after earlier guidance against PSA testing for all patients. Increased testing was also observed among older men, who may be less likely to benefit from prostate cancer screening,” authors of the study concluded.