Third Anniversary of Ruling Against PSA Screening: Has Anything Changed?

It’s been three years since the US Preventive Services Task Force issued a recommendation against routine PSA screening for prostate cancer in otherwise healthy men or men who were not at known risk for the disease. It was controversial then—and not much has changed.

A multi-institution team published a research letter in the Journal of the American Medical Association (JAMA) entitled “Contemporary Nationwide Patterns of Self-reported Prostate-Specific Antigen Screening”.[i] The authors investigated actual PSA screening numbers in the three years since the ruling was promulgated. They found that an estimated 17 million men age 50 years or older with no history of prostate cancer or prostate problems have their PSA regularly tested. However, they discovered wide variance in patterns of screening from one demographic to another, and among geographic locations.

Drawing upon the 2012 Behavioral Risk Factor Surveillance System, they were able to analyze data according to factors such as age, ethnicity, education, income, etc. Not surprisingly, men who had access to regular health care, especially those with income at least $75,000, a college education and medical insurance had the highest screening rates. The age group 70-74 had the greatest reported screening rates of all age groups, closely followed by 65-69. The state with the highest self-reported rate was Hawaii (59.4%) with the lowest being New Hampshire (24.5%). The researchers said their findings likely reflect “both the considerable disagreement among experts and the conflicting recommendations on PSA screening.

In all, the team concluded that the national guidelines had a limited effect on what’s actually going on in the screening world.

I suspect that the national prostate cancer advocacy organizations are relieved by the team’s findings, since they generally support early detection even while acknowledging the flaws of the non-cancer-specific PSA test. I can only wonder if the Panel members are surprised or discouraged at making so little impact on conventional prostate cancer screening.

 


 

[i] Sammon J, Pucheril D, Diaz M, Kibel A et al. Contemporary nationwide patterns of self-reported prostate-specific antigen screening. JAMA. 2014 Sep 1. doi:10.1001/jamainternmed.2014.4117.

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