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Study: Prostate Cancer Screening Recommendations Have Little Effect

Authors focus on use of PSA test

The effect of guidelines recommending that elderly men should not be screened routinely for prostate cancer “has been minimal at best,” according to a study led by researchers at Henry Ford Hospital in Detroit, Michigan.

The study, published as a research letter online in JAMA Internal Medicine, focused on the use of prostate-specific antigen (PSA) to test for prostate cancer.

“We found that the effect of the guidelines recommending against the routine screening of elderly men in particular has been minimal at best,” said lead author Jesse Sammon, DO. The researchers found an estimated 17 million men age 50 or older without a history of prostate cancer or prostate problems who reported undergoing PSA screening.

Although the PSA test is credited with a significant improvement in 5-year cancer survival rates during the first decade after the FDA approved its use in men without symptoms, use of the test for routine screening is controversial.

“The concern is that the test often provides false positives, leading subjects who do not have a prostate malignancy to undergo treatment they don’t need and suffer such side effects as impotence and urinary incontinence,” Sammon said.

Nearly 3 years ago, the debate led the U.S. Preventive Services Task Force (USPSTF) to recommend against routine PSA screening in any age group. “But in the time since, nationwide patterns of PSA screening were largely unknown,” Sammon said. “We sought to examine those patterns to determine the effects of the most recent USPSTF recommendation.”

The researchers drew their data from the 2012 Behavioral Risk Factor Surveillance System, the world’s largest continuously conducted health survey. 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.

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 being between the ages of 70 and 74 years. The next highest rate of screening — by only a fraction of a percentage point — was in men aged 65 to 69. Those aged 50 to 54 were found to be the least likely to report PSA screening, although several professional medical organizations have previously recommended screening for that age group.

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

“Looking at rates of colorectal and breast cancer screening, state-by-state and regional variability is expected,” Sammon explained, “but not to the pronounced extent that we found for PSA screening. This was another concerning and surprising study finding. It’s alarming that the prevalence of PSA screening can double from one state to the next.”

The authors noted that 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,” Sammon said.

Source: Henry Ford Health System; September 18, 2014.

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