Contemporary National Trends of Prostate Cancer Screening Among Privately Insured Men in the United States

Abstract

To assess the possible impact of changes to the clinical guidelines from the US Preventive Services Task Force recommendations in 2012 on the national trends of prostate-specific antigen (PSA) screening and identify patient characteristics associated with PSA screening from a large private insurance database. We conducted a retrospective cohort study of men between 40 and 80 years of age who underwent PSA screening for prostate cancer from 2008 to 2013 in a population-based cohort of privately insured patients. Unadjusted and adjusted rates were calculated using member-years and reported per 1000 member-years. Rates of PSA screening remained stable from 190.4 per 1000 member-years in 2008 to 196.4 in 2013 (P = .66). From 2008 to 2013, PSA screening did not change for patients aged 50-59 (236.5 to 241.1 per 1000 member-years; P = .78), 60-64 (284.1 to 288.3 per 1000 member-years; P = .77), 65-69 (250.6 to 248.0 per 1000 member-years; P = .56), and 70-74 (266.4 to 280.3 per 1000 member-years; P = .17). However, patients ≥75 years had marked decrease in the rate of PSA screening from 201.5 to 124.1 per 1000 member-years (P = .04). Across different racial groups, PSA screening rates remain unchanged over time irrespective of age. Among this population-based cohort of privately insured men, we found little effect on PSA screening from changes to the US Preventive Services Task Force clinical practice guidelines. However, the rates of PSA screening were much lower among older men (>75 years). Further research is needed to assess the impact of the new guidelines on prostate cancer incidence and survival.