PD43-12 PSA SCREENING, PROSTATE BIOPSY, AND TREATMENT OF PROSTATE CANCER IN THE YEARS SURROUNDING THE USPSTF RECOMMENDATION AGAINST PROSTATE CANCER SCREENING

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2017PD43-12 PSA SCREENING, PROSTATE BIOPSY, AND TREATMENT OF PROSTATE CANCER IN THE YEARS SURROUNDING THE USPSTF RECOMMENDATION AGAINST PROSTATE CANCER SCREENING James Kearns, Sarah Holt, Jonathan Wright, Daniel Lin, Paul Lange, and Jonathan Gore James KearnsJames Kearns More articles by this author , Sarah HoltSarah Holt More articles by this author , Jonathan WrightJonathan Wright More articles by this author , Daniel LinDaniel Lin More articles by this author , Paul LangePaul Lange More articles by this author , and Jonathan GoreJonathan Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1917AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2012 USPSTF recommendation against screening for prostate cancer has impacted rates of PSA screening and appears to be associated with declining prostate cancer incidence. Our objective was to examine a large, national claims-based database to characterize health care utilization that may explain these trends. We evaluate rates of PSA testing, prostate biopsy, prostate cancer detection, and treatment in the years surrounding the USPSTF recommendation. METHODS MarketScan (which captures > 30 million privately insured patients in the United States) claims were queried for all men age 40-64 years between 2008-2013. The at-risk population consisted of men without a diagnosis of prostate cancer. PSA testing, prostate biopsy, prostate cancer diagnosis and treatment were determined using ICD-9 and CPT codes. Prostate cancer cases were defined as men who underwent prostate biopsy and then had ≥ 2 encounters within 6 months with a prostate cancer diagnosis. Treatments ascertained included treatments for curative intent of localized prostate cancer (i.e., radical prostatectomy, external beam radiation, brachytherapy) and systemic treatments. RESULTS There were 5.27 - 6.79 million qualifying men in MarketScan each year. PSA testing, prostate biopsy, and prostate cancer detection declined significantly from 2009 to 2013 (Figure), most notably between 2011 and 2012. Prostate biopsy rate per 100 patients with a PSA test decreased from 2.31 to 1.85 (p < 0.01). Prostate cancer incidence per prostate biopsy increased from 0.356 to 0.380 (p < 0.01). Treatment for localized prostate cancer decreased from 2009 to 2013 from 154 per 100,000 men to 112 per 100,000 men (p < 0.01). Over the same study period, systemic treatment also decreased from 5.64 per 100,000 men to 4.70 per 100,000 men, p < 0.01). Of new prostate cancer diagnoses, the proportion managed with treatment for curative intent decreased from 67% to 60% (p < 0.01). CONCLUSIONS PSA testing, prostate biopsy, prostate cancer incidence, and treatment for prostate cancer decreased in the years surrounding the USPSTF recommendation against prostate cancer screening. The changes in incidence following the USPSTF statement may be driven by different practice patterns around PSA-based referral and prostate biopsy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e822-e823 Advertisement Copyright & Permissions© 2017MetricsAuthor Information James Kearns More articles by this author Sarah Holt More articles by this author Jonathan Wright More articles by this author Daniel Lin More articles by this author Paul Lange More articles by this author Jonathan Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...