Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation...

Area of Science:

• Urology
• Preventive Medicine
• Health Policy

Background:

• The US Preventive Services Task Force (USPSTF) shifted its stance on prostate-specific antigen (PSA) screening for prostate cancer.
• Initial 2012 guidance advised against PSA screening (Grade D), but a 2017 draft recommendation endorsed individualized decision-making for men aged 55-69 (Grade C).

Purpose of the Study:

• To analyze changes in PSA testing rates subsequent to the USPSTF guideline revisions.
• To assess the impact of the USPSTF's draft and final recommendations on PSA screening practices.

Main Methods:

• Retrospective cohort study utilizing deidentified claims data from Blue Cross Blue Shield beneficiaries (ages 40-89) from 2013-2019.
• Analysis of age-adjusted PSA testing rates before (2016) and after (2019) the guideline changes.
• Interrupted time series analysis to evaluate the association between USPSTF recommendations and PSA testing trends.

Main Results:

• Overall PSA testing rates increased by 12.5% between 2016 and 2019.
• Testing rates rose across all age groups: 10.1% in men 40-54, 12.1% in men 55-69, and 16.2% in men 70-89.
• A statistically significant increasing trend in PSA testing was observed after the April 2017 draft recommendation.

Conclusions:

• PSA testing rates increased following the USPSTF's 2017 draft statement, reversing previous downward trends.
• The updated guidance led to increased screening, including in older men who may not benefit significantly from screening.
• These findings highlight the impact of guideline changes on clinical practice and screening behavior.