Impact of the 2008 U.S. Preventative Services Task Force recommendation on frequency of prostate-specific antigen screening in older men

Abstract

Objectives: To evaluate the effect of the 2008 U.S. Preventative Services Task Force recommendation against prostate-specific antigen (PSA) screening in men aged 75 and older on frequency of PSA screening in elderly men.

Design: Retrospective, cross-sectional analysis.

Setting: Fifteen community primary care practices in western Massachusetts.

Participants: Men aged 65 and older with one or more annual physicals between January 1, 2006, and December 31, 2010.

Measurements: PSA testing was determined from the electronic health record. Mixed-effects logistic regression was used to model the rate of PSA testing over time for two age groups: 65 to 74, and 75 and older.

Results: Of the 7,833 men in this study, 60% were younger than 75. PSA screening rates were consistently lower in men aged 75 and older. Annual rates, adjusted for number of clinic visits, ranged from 12% to 28% in men aged 75 and older, and 37% to 49% in men aged 65 to 74. In the 2 years before the guideline was released, there was already a slow decline in screening rate in men aged 75 and older, whereas the screening rate in men aged 65 to 74 was rising. Compared to 2008, there was a 36% relative reduction in screening rate in 2009 and a 51% relative reduction in 2010 for men aged 75 and older, and a 12% relative reduction in screening rate in 2009 and a 24% relative reduction in 2010 for men aged 65 to 74.

Conclusion: The 2008 recommendation appeared to reduce PSA screening rates in older men in 2009 and 2010; there was a substantial reduction in men aged 75 and older and a more modest reduction in men aged 65 to 74.

Keywords: USPSTF recommendations; cancer screening; elderly men; prostate cancer; prostate-specific antigen.