Neil Osterweil

September 15, 2016

LAS VEGAS — Clinicians in the United States continue to use prostate-specific antigen (PSA) testing to screen men for prostate cancer, despite recommendations from the US Preventive Services Task Force to the contrary, a review of data on 92 million men shows.

"There has been an impact of the recommendations, but it has been very modest," said Shahram Shahangian, PhD, from the Center for Surveillance, Epidemiology, and Laboratory Services at the Centers for Disease Control and Prevention (CDC).

"We are dealing with about a 10% decline in utilization. But the fact that testing continues in the older population, where there should not be any testing done, is very disappointing," he told Medscape Medical News.

Dr Shahangian presented the data here at the Pathology and Lab Medicine 2016 American Society for Clinical Pathology Annual Meeting.

In 2008, the task force recommended against the use of PSA-based screening for prostate cancer for men younger than 50 years and older than 74 years. In 2012, the group went further and recommended against any PSA-based screening.

Other organizations, however, maintain that there is still a limited role for PSA screening. The American Urological Association, for example, recommends that PSA screening be offered to men 50 to 69 years of age who have a minimum of 10 remaining years of life expectancy, but only after informed consent and shared decision making.

 
The fact that testing continues in the older population, where there should not be any testing done, is very disappointing.
 

In his retrospective review, Dr Shahangian looked at outpatient claims data on 91.8 million men from the Truven Health Analytics MarketScan databases and Medicare supplemental data from 2009 to 2014. Claims related to any of 62 prostate or urinary conditions that could have indicated reasons for PSA testing other than screening were excluded from the analysis.

In four regions of the country — the Mountain states, Middle-Atlantic states, West North Central states, and New England states — PSA screening rates for men 50 to 69 years of age declined during the study period (P for trend = .011). The sharpest drop occurred in New England.

Overall, for men 50 to 69 years of age, there was a modest 3.6% decline in PSA screening rates (P = .035), Dr Shahangian reported. For men younger than 50 years, where there was a significant but modest decline of 8.9% (P = .002).

For men 70 years and older, PSA screening rates decreased by 10.2% during the study period, but the trend in this age group was not significant.

"These findings call for the design, evaluation, and implementation of interventions to decrease unwarranted PSA screening, such as in average-risk men who are younger than 50 or older than 69 years of age with at least 10 years of remaining life expectancy," he reports.

"There is a need for broader utilization of test-ordering mechanisms, where a clinician's request for testing of older men would not be accepted as part of the institution's testing algorithm," Dr Shahangian told Medscape Medical News.

In addition, he called for a change in healthcare policy, so that PSA screening for older men would not be reimbursed.

 
Regrettably, there has been a disconnect between the CMS coverage for PSA testing and what the evidence indicates.
 

"Regrettably, there has been a disconnect between the CMS coverage for PSA testing and what the evidence indicates," he explained.

When cancer is involved, patients and clinicians are often reluctant to abandon long-standing practice, however questionable, said Bryan Rea, MD, a pathology fellow at the Hospital of the University of Pennsylvania in Philadelphia, who was not involved in the study.

"It's interesting that despite the recommendations that have come out, things really haven't changed all that much," he said. "It shows that people are pretty reluctant to give up these ingrained practices of testing for PSA."

This study was funded by the CDC. Dr Shahangian and Dr Rea have disclosed no relevant financial relationships.

Pathology and Lab Medicine 2016: the American Society for Clinical Pathology (ASCP) Annual Meeting. Presented September 14, 2016.

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