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Frequent PSA Screening for Prostate Cancer Likely Leads to Overdiagnosis
The U.S. Preventive Services Task Force (USPSTF) recommends shared decision-making about prostate-specific antigen (PSA) screening for prostate cancer in older men (age range, 55–69; NEJM JW Gen Med Jun 15 2018 and JAMA 2018; 319:1901); the American Urologic Association (AUA) agrees and recommends a screening interval of at least 2 years to minimize potential harms. Some men, however, seek PSA screening more frequently.
Using a claims database, researchers identified 3 million men (age, ≥30; 70% white) with either Medicare or private insurance who had ≥2 years of continuous insurance enrollment after their first PSA test between 2003 and 2019. “High-frequency PSA testing” was defined as ≥3 PSA testing intervals ≤270 days. Men who lost insurance or received diagnoses of or treatment for prostate cancer were dropped from the cohort.
The overall incidence of high-frequency PSA testing was 5%; incidence increased by about 0.5% annually, regardless of changes in guidelines. Men were more likely to have high-frequency testing if they were older, less educated, and nonwhite. Men with and without high-frequency testing had similar PSA levels; most men never had PSA levels >4 ng/dL, regardless of testing frequency. Men with high-frequency testing were significantly more likely than other men to have prostate biopsies and to receive diagnoses of prostate cancer; however, they were treated no more quickly, suggesting that much of the difference in incident cancer was due to overdiagnosis.
Primary care clinicians can use these data to advise patients that risks of high-frequency PSA testing likely exceed benefits.
Peterson DJ et al.
Title: Prosteria — National trends and outcomes of more frequent than guideline recommended prostate specific antigen screening.
Source: Urology 2023 Apr ; [e-pub]. (Abstract/FREE Full Text)