MP40-03 CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING AND PROSTATE CANCER DIAGNOSIS AFTER GUIDELINE CHANGES

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2018MP40-03 CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING AND PROSTATE CANCER DIAGNOSIS AFTER GUIDELINE CHANGES Christopher J. Magnani, Kevin Li, Tina Seto, Kathryn M. McDonald, Douglas W. Blayney, James D. Brooks, and Tina Hernandez-Boussard Christopher J. MagnaniChristopher J. Magnani More articles by this author , Kevin LiKevin Li More articles by this author , Tina SetoTina Seto More articles by this author , Kathryn M. McDonaldKathryn M. McDonald More articles by this author , Douglas W. BlayneyDouglas W. Blayney More articles by this author , James D. BrooksJames D. Brooks More articles by this author , and Tina Hernandez-BoussardTina Hernandez-Boussard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (CaP) is the most common cancer in men, yet consensus for screening practices is lacking. In 2012, the US Preventative Services Task Force (USPTF) recommended against Prostate Specific Antigen (PSA) screening across all age groups. We evaluated the impact of this recommendation on population level screening and stage of diagnosed CaP. METHODS We identified men aged 35+ receiving care at our academic institute using electronic medical records. To assess the impact of the guideline recommendations, we compared changes in PSA screening rates among men undiagnosed with CaP before (2008-2011) and after (2013-2016) the USPTF recommendation with changes in the same period for cholesterol and thyroid-stimulated hormone (TSH) screening, which were unaffected by the USPSTF change, using a difference-in-differences analysis adjusted for secular trends, age, race, insurance, and comorbidities. The 2012 data were excluded as a washout year. RESULTS We identified a total of 789,557 men eligible for screening on an annual basis: 264,265 pre- and 525,292 post-guideline changes, which included 2,839 and 1,609 new CaP diagnoses, respectively. Our models suggest that following USPTF changes, PSA screening had a significant relative decrease of 6.3% and 1.8% compared to cholesterol and TSH, respectively. The greatest decreases were observed among men < 55 (-6.7% and -3.3%) and > 75 years of age (-8.0% and -1.5%). Regarding CaP diagnoses, 74.3% were early stage (T1/T2) pre-USPSTF compared to 66.4% post-USPSTF (p<0.0001). We observed declines in early stage diagnoses from 80% to 69% (p=0.021) in men < 55, 71% to 65% (p=0.007) in men 55-75, and 89% to 81% (p=0.285) in men > 75. CONCLUSIONS These results suggest PSA testing decreased among males aged 35 and older following the 2012 USPSTF guideline changes, and was accompanied by decreased diagnosis rates of low-risk, localized CaP. This study highlights the potential for guidelines to increase efficient and effective medical care and potentially reduce overtreatment in CaP patients, though the impact on CaP-specific survival is unknown. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e520 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher J. Magnani More articles by this author Kevin Li More articles by this author Tina Seto More articles by this author Kathryn M. McDonald More articles by this author Douglas W. Blayney More articles by this author James D. Brooks More articles by this author Tina Hernandez-Boussard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...