357 Prostate-Specific Antigen (PSA) Screening Rates in the United States, 2009–2015: Implications for Practice Interventions

Abstract

Prostate-specific antigen (PSA) is the most commonly used cancer screening test in men. Currently, there are two sets of recommendations for PSA screening: one championed by the US Preventive Services Task Force against screening of men of all ages, and the other by the American Cancer Society for offering screening only to 50- to 69-year-old men after informed/shared decision making. We evaluated PSA screening rates from 2009 through 2015. Claims for PSA screening of asymptomatic men, done by excluding PSA testing associated with 62 prostate or urinary conditions, were collected using Medicare (17.7–21.8 million men >64 years old) and MarketScan (9.9–16.5 million men 30–64 years old) databases. Trend tests were performed using a two-sided Poisson regression with Bonferroni correction. Annual PSA screening rates were 2% in men aged 30–39, 13%-14% in men aged 40–49, 29%-31% in men aged 50–59, 33%-36% in men aged 60–64, 9%-13% in men aged 65–69, 11%-15% in men aged 70–74, and 9%-13% in men aged ≥75 years. Downward temporal trends were significant for ages 60–64 years (P = .002) and 70–74 years (P = .004). The 2009 to 2015 change in screening rate ranged from a decrease of 16% in men aged 70–74 years to an increase of 2% in men aged 30–39 years. Overall, PSA screening has decreased. Despite all recommendations against screening men aged <50 and >69, PSA screening is still performed in these age groups. In the >49 age group, PSA screening rate decreased presumably due to combined influence of all recommendations. There is a need to further understand why consensus recommendations for screening of men <50 and >69 are not fully followed. These results might also suggest continued opportunities for laboratory professionals to work with clinicians to implement only evidenced-based laboratory screening recommendations.