Message to Forgo PSA screening Is Not ‘Getting Through’
Screening of healthy men with the prostate-specific antigen (PSA) blood test has increased in recent years in the United States.
This is despite the fact that the US Preventive Services Task Force has recommended against routine screening of healthy men since 2012.
There was a bit of a change in 2017, when the Task Force changed the recommendation for men aged 55–69 years. For this age group, it recommended that PSA screening be considered on a case-by-case basis.
However, it continued to recommend against screening for younger (aged 40–54 years) and older (aged 70 and older) men, owing to a greater likelihood of harm, particularly the detection and treatment of harmless tumors in senior citizens.
Physicians might have missed the fine print.
A new report shows that there was a 12.5% relative increase in rates of PSA testing for men aged 40–89 years from 2016–2019.
A significant increase in screening (12.1%) occurred among patients aged 55–69 years, for whom screening is specified by the guideline.
Screening also increased significantly in the other two age groups ― it increased by 10.1% in men aged 40–54 years and by 16.2% in men 70–89 years. For both of these age groups, screening is not recommended, the authors note.
The report was published online on November 11 in JAMA Oncology.
“It is now evident that the long-term practice of a PSA test followed by systematic biopsies of the prostate is antiquated,” comments urologist Freddie Hamdy, MD, a professor and prostate cancer researcher at the University of Oxford, Oxford, United Kingdom, in an accompanying editorial.
“When will the message get through to the public, clinicians, and health care professionals that inappropriate PSA testing outside evidence-based recommendations should cease?” he asks.
The Findings in Detail
The study was led by urologist Michael Leapman, MD, a prostate cancer specialist at Yale University, in New Haven, Connecticut.
The team investigated screening rates among a large cohort of privately insured men (US Blue Cross Blue Shield beneficiaries) from 2013–2019. The bimonthly mean number of men in the cohort was over 8 million.
They found that PSA screening increased from 2016–2019 overall and in each of the three age groups.
It is possible that the increase in screening that occurred in the younger age group was prompted by emerging evidence supporting the prognostic value of having a baseline PSA at middle age, the authors comment.
However, “the persistence of overly simplistic diagnostic pathways,” such as relying on a single PSA cut point to trigger biopsy, continues to put men at risk for detection and treatment of indolent tumors, they warn.
The team calls for guideline groups and payers to offer clear guidance on how to use the many techniques that have emerged over the past decade to distinguish harmless tumors from lethal ones, including the use of risk calculators, prebiopsy biomarkers, and polygenic risk scores, which by and large have not been widely adopted in the United States.
“Embracing an MRI-centered approach to biopsy selection, as has been accepted in several countries, would [also] be a significant step” in the right direction, they say.
The study was funded by the National Cancer Institute. Leapman has disclosed no relevant financial relationships. Several authors have reported ties of numerous drug companies. Hamdy has received personal fees from Intuitive Surgical.
JAMA Oncol. Published online November 11, 2021. Abstract, Editorial
M. Alexander Otto is a physician assistant with a master’s degree in medical science. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. He is an MIT Knight Science Journalism fellow. Email: [email protected].
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