Joseph S. Ross, MD, MHS, assistant professor of internal medicine at Yale University, and colleagues found that a 2008 recommendation to stop PSA-based prostate cancer screening in older men had only a small effect on screening. Image: Yale University
The rate of prostate cancer screening by testing prostate-specific antigen (PSA) levels among men age 75 years or older declined just 2 percentage points after a 2008 recommendation from the US Preventive Services Task Force (USPSTF) to discontinue such screening in this age group because the benefits were outweighed by the risks for these older patients, according to a study published in the Archives of Internal Medicine today.
Since the 2008 USPSTF recommendation, a growing body of evidence has suggested that routine PSA-based screening for prostate cancer saves few lives and may expose many men to serious and unnecessary harms from follow-up screening or unnecessary treatment. Based on such evidence, in May 2012 the USPSTF recommended an end to PSA-based prostate cancer screening for all men.
It is too soon to gauge the effect of the 2012 recommendation on prostate cancer screening. But a team of researchers has analyzed the effect of the 2008 USPSTF recommendation on PSA-based prostate cancer screening in older men. They found that the rate of screening among men 75 years or older dipped about 2 percentage points from 29.4% prior to the recommendation to 27.8% after the recommendation. The screening rate remained steady in a younger population of men.
Joseph S. Ross, MD, MHS, assistant professor of internal medicine at Yale University in New Haven, Conn, spoke with news@JAMA about the implications of the findings.
news@JAMA: What do your findings tell us about the effect of the 2008 USPSTF recommendation?
Dr Ross: There was a small but detectable difference in PSA screening among the men older than 75 relative to men between 65 and 75.
news@JAMA: Why do you think your results differed from other studies that found no difference in screening after the recommendation?
Dr Ross: There were methodological differences between our studies and others. We used younger men as a comparison group to detect whether other changes in screening were occurring during that period.
news@JAMA: What are the implications of your findings for the more recent recommendation to discontinue PSA screening?
Dr Ross: It should make policy makers realize it?s difficult to change physician behaviors. You can?t expect that just by making a statement, physicians are going to change behavior. If the intervention does cause more harm than benefit, policy makers may need to more aggressively try to change behavior.
news@JAMA: Why do you think physicians may be reluctant to follow the guideline?
Dr Ross: While the USPSTF recommendation may be based on the evidence from the best research to date, physicians may feel strongly about anecdotal evidence that the screening helped a particular patient. The controversy itself also leads to misleading information. Other groups come out and say they disagree. This makes it harder for physicians to feel as confident in their decisions.
news@JAMA: What can be done to ensure that physicians more quickly adopt evidence-based recommendations?
Dr Ross: It?s very difficult to change practice patterns because physicians have so much autonomy. The easiest way is to change reimbursement, but that is even more controversial. So a lot of education is needed for both physicians and patients about the risks and benefits of prostate cancer screening.
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