USPSTF Recommendation Did Not Impact PSA Testing Referrals, Study Finds

A study published in the journal Cancer has discovered that a 2012 recommendation for prostate cancer screening did not change physician behavior.

A study published in the journal Cancer has evaluated real-world data on prescribing patterns of physicians and clinical practices following a 2012 guideline change by the US Preventive Services Task Force (USPSTF) for prostate-specific antigen (PSA) testing. USPSTF gave a D rating to PSA testing for screening for prostate cancer, saying the harms outweighed benefits. The current study has found that the recommendation did not significantly change physician behavior.


The authors analyzed PSA orders and urology referrals from a tertiary referral center in the southern United States. The order was classified as a screening test if ordered by physicians who had an appointment in internal medicine, family medicine, or general internal medicine.


Over a 5-year period between January 2010 and July 2015, 63,722 PSA orders were made, of which 54,684 could be evaluated. These were a part of 275,784 unique ambulatory visits that were documented. Primary care providers (PCPs), the study found, ordered 17,315 PSA tests and 858 urology referrals. The PSA value at the time of referral was significantly higher (P = .022). However, the number of PSA tests per ambulatory visit, the number of referrals per ambulatory visit, the age at the time of the urology referral, and the proportion of PSA tests performed outside the recommended age range did not significantly change.


Based on their results the authors conclude that there was no significant impact on physician referral behavior post the USPSTF recommendation.


This data contrasts a similar study published earlier this year in JAMA Internal Medicine, where the authors gathered data from the National Ambulatory Medical Care Survey to examine continued adoption of PSA testing and found more than a 50% drop in preventive PCP visits, from 36.5% in 2010 to 16.4% in 2012, and just a slight drop in urologist visits. The difference in outcomes might be the result of a difference in the demographics and even the study duration following the recommendation.

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