PSA Screening for Prostate Cancer Declined from 2007 to 2013

The U.S. Preventive Services Task Force recommended against prostate cancer screening with prostate specific antigen (PSA) in men 75 years and older in 2008, and then extended that recommendation to all men in 2012 (NEJM JW Gen Med Jul 1 2012 and Ann Intern Med 2012; 157:120). In two studies, researchers looked at the effect of those recommendations on screening and cancer diagnosis.

In the first study, investigators used national health behavior and cancer surveillance databases to compare screening rates and prostate cancer diagnoses for 2005, 2008, 2010, and 2013. In adjusted analyses, screening rates increased for both middle-aged (age range, 50–74) and older (age, ≥75) men from 2005 to 2008; screening rates declined from 2008 to 2013. The absolute rates of screening in 2013 for the younger and older subgroups were 30% and 36%, respectively. Annual prostate cancer incidence increased from 2005 to 2007 and then declined steadily from 593 cases per 100,000 men in 2007 to 416 per 100,000 in 2012.

In the second study, the same national health behavior database was used to identify roughly 5000 middle-aged and older men in each study year (2000, 2005, 2010, and 2013). PSA screening rates were 34% in 2000 and 2005, 36% in 2010, and 31% in 2013. The 2013 decline was driven by lower screening rates in men younger than 75, particularly those younger than 55 (23% in 2010 vs. 18% in 2013) and those who were 60 to 64 (45% in 2010 vs. 35% in 2013).