Professional recommendations against prostate cancer screening have little impact on practice

The effect of guidelines recommending that elderly men should not be routinely screened for prostate cancer has been minimal at best, according to a new study.

"We found that the effect of the guidelines recommending against the routine screening of elderly men in particular has been minimal at best," said lead author Jesse Sammon, DO, a researcher at Henry Ford Hospital's Vattikuti Urology Institute in Detroit, Michigan. The study was published as a research letter in JAMA Internal Medicine (2014; doi:10.1001/jamainternmed.2014.4117).

The researchers report that an estimated 17 million men age 50 years or older without a history of prostate cancer or prostate problems undergo PSA screening. Though credited with a significant improvement in 5-year cancer survival rates during the first decade after the FDA approved PSA testing of men without symptoms, its use for routine screening is controversial.

"The concern is that the test often provides false-positives, leading [men] who do not have a prostate malignancy to undergo treatment they don't need and suffer such side effects as impotence and urinary incontinence," said Sammon.

Nearly 3 years ago, the debate led the US Preventive Services Task Force to recommend against routine PSA screening in any age group.

"But in the time since, nationwide patterns of PSA screening were largely unknown," said Sammon. "We sought to examine those patterns to determine the effects of the most recent USPSTF recommendation."

The researchers drew their data from the 2012 Behavioral Risk Factor Surveillance System, the world's largest continuously conducted health survey. The study group was analyzed according to age, race and/or ethnicity, education, income, residence location, insurance status, access to regular health care, and marital status.

Higher rates of screening were most strongly associated with access to regular health care, followed by an income greater than $75,000, college education, health insurance, and those age 70 to 74 years. The next highest rate of screening, differing by only a fraction of a percentage point, was in men age 65 to 69 years. Those age 50 to 54 years were found to be the least likely to report PSA screening, although several professional medical organizations have previously recommended screening for that age group.

In addition, an analysis of self-reported PSA screening across the United States found the highest rate (59.4%) in Hawaii and the lowest (24.5%) in New Hampshire.

"Looking at rates of colorectal and breast cancer screening, state-by-state and regional variability is expected," Sammon explained, "but not to the pronounced extent that we found for PSA screening. This was another concerning and surprising study finding. It's alarming that the prevalence of PSA screening can double from one state to the next."

The researchers said their findings likely reflect "both the considerable disagreement among experts and the conflicting recommendations on PSA screening.

"Taken together, these results suggest that national guidelines have had a limited effect on clinical practice among health care providers," said Sammon.

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