Adherence to the U.S. Preventive Services Task Force 2011 recommendations on PSA screening differed significantly from state to state, according to findings recently published in Urology.
The USPSTF recommended against the use of PSA testing for prostate cancer screening in all men 6 years ago, according to researchers. Conversely, the American College of Physicians, the American Urological Association and the American Society of Clinical Oncology suggest patients make informed decisions about PSA screening based on discussions with their physicians, they added.
“Given this controversy, there is still lively discussion on the implications and consequences of PSA screening in the United States,” Malte W. Vetterlein, MD, of the Vattkuti Urology Institute in Detroit, and colleagues wrote. “Due to this general uncertainty, documenting changes in PSA screening are key to understanding practice patterns.”
Data on regional trends for this screening are lacking, researchers added.
Researchers hypothesized that PSA screening trends fluctuated by state after the 2011 USPSTF recommendation. They also hypothesized that these trends were independent from trends for breast and colorectal cancer screening, for which USPSTF has not changed its recommendations.
Vetterlein and colleagues analyzed data from 222,475 men 50 years of age or older who participated in the Behavioral Risk Factor Surveillance System surveys in 2012 and 2014. Data from men in Guam and Puerto Rico was not included.
Researchers determined the unadjusted and weighted self-reported occurrence of PSA screening for the years 2012 and 2014 at the countrywide and state levels. They then utilized weighted multivariate logistic regression models to identify independent predictors of PSA screening in the years 2012 and 2014. Covariates included access to health care, age category, education level, health insurance status, income, marital status, race/ethnicity, smoking status and state of residence. Researchers compared the rates with the rates of colorectal and breast cancer screenings in a similar population for the same 2 years.
Vetterlein and colleagues found that a “vast state-by-state heterogeneity” in the PSA screening rates existed in 2012 and 2014, ranging from Vermont, which saw a relative 26.6% decrease and Hawaii, which saw a relative 10.2% increase. Oklahoma served as the reference state, having the median PSA screening rate in the pooled data (35.2%).
In addition, the prevalence of PSA screening remained unchanged in 14 states, significantly increased in Texas and Hawaii and significantly decreased in 35 states and Washington, D.C.
Nationwide, 38.9% (95% CI, 38.6–39.2) of those surveyed reported undergoing PSA screening in 2012 vs. 35.8% (95% CI, 35.1–36.2) in 2014. Adjusted analyses showed the nationwide prevalence of PSA screening decreased by a relative 8.5% (95% CI, 6.4-10.5) between 2012 and 2014. Researchers also found that all the covariates were independent predictors of the screening in both years (all P < .001).
“It is noteworthy that men with income of greater than $50,000, access to health care, and those who had health insurance were more frequently screened,” Vetterlein and colleagues wrote.
In addition, 81.5% of the overall changes in PSA screening were not reflected in colorectal cancer screening and 84% of the changes were not reflected in breast cancer screening, according to researchers.
“Our study is the first to measure the impact of those interference factors on changes in PSA screening over time,” Vetterlein and colleagues wrote.
Earlier this year, the USPSTF issued a draft recommendation against PSA screening for prostate cancer in all men, determining that the decision about whether to be screened should be an individual one. An announcement regarding the Task Force’s final recommendation has not been scheduled. – by Janel Miller
Vetterlein reports no relevant financial disclosures. Please see the study for a full list of the other authors relevant disclosures.