Prostate-specific antigen testing in men aged 40-64 years: impact of publication of clinical trials

Abstract

We assessed the impact of the publication of trials and changes in recommendations on the rates of prostate-specific antigen (PSA) screening in men aged 40 to 64 years by analyzing monthly medical claims for PSA testing in a commercial insurance database from 2001 to 2011, covering more than 1.5 million men in each year. The testing rates for men aged 40 to 49 years, 50 to 59 years, and 60 to 64 years were 12.1%, 32.7%, and 42.7%, respectively, in 2001 vs 15.7%, 34.2%, and 42.0%, respectively, in 2011. Men aged 40 to 49 years experienced a gradual increase in testing rate from 2001 through 2008 (annual change in PSA testing per 10,000 men [AC] = 4.37; P < .001), which became flat from mid-2009 through 2011(AC = -0.06; P =.98). The slope of PSA testing rates did not change in men aged 50 to 59 years or 60 to 64 years with the publication of the results of the large trials in 2009 or with the subsequent changes in recommendations on PSA testing.

Figure 1.

Monthly prostate-specific antigen (PSA) testing rates for men aged 40 to 49 years, 50 to 59 years, and 60 to 64 years from 2001 through 2011. The annual change in rate (AC) represents the change in number of men tested per 10 000 men per year. The AC for men aged 50 to 59 years and the initial AC (from the period from 2001 to 2009) for men aged 40 to 49 years were statistically significant (P < .001) using Z score statistics. The other ACs were not significantly different from 0 (no change over time). The joinpoint regression detected a statistically significant change (node) in the slope of rate of PSA testing at July 2009 for the group aged 40 to 49 years, indicated by the vertical arrow.