Introduction

In 2012, the USPSTF recommended against prostate specific antigen (PSA)-based PCa screening in all men, regardless of age and/or race. Initial reports showed a substantial drop in PSA screening in response to these recommendations, which was mainly evident in younger patients (aged <75 years old). Our objective was to determine if the downward trend continued past the immediate response to the recommendation, and if it varied by age and race.

Methods

We evaluated a total of 17,554 men aged 50 years or older, who were interviewed by the National Health Interview Survey 2010, 2013, and 2015. PSA screening was defined as men undergoing PSA testing in the past 12 months preceding survey year for reasons other than prostate cancer/disease. Prevalence of PSA screening per survey year was assessed in the entire cohort, and after stratifying according to age and race. Multivariate logistic regression model calculated the odds of receiving PSA screening in 2013 and 2015 compared to 2010. Interaction analysis were performed using age and race, to examine if these variables modify the effect of survey year on the odds of PSA screening. Covariates consisted of age, race, region, marital status, education, insurance, smoking status, health status, primary care physician visit in the past year and income.

Results

Mean (median) age was 63.4 (61.2) years. Men age was 50-69, 70-74, and ?75 years in 74.2%, 10%, and 15.8% of cases, respectively. Most patients were White (77%), Married (58%), had Private insurance (47%), and had a household income <$35,000 (34%). The prevalence of PSA screening in 2010 was 35.1% (95% confidence interval [CI]: 31.5%-39.5%). This decreased to 30.5% (95%CI: 33.5%-36.6%) in 2013 and 30.1% (95%CI: 28.8 %-31.4%) in 2015. After adjusting for covariates, in comparison to survey year 2010, 2013 (odds ratio [OR]: 0.79; 95%CI: 0.72 – 0.87) and 2015 (OR: 0.71; 95%CI: 0.64 – 0.78) was associated with lower odds of PSA screening (both p<0.001). On interaction analysis, neither age (p=0.8) nor race (p=0.3) was statistically significant.

Conclusions

Our findings show that the initial significant drop (4.6%) in PSA screening, which occurred in the first year following the 2012 USPSTF recommendation, was not maintained in the subsequent years (drop of 0.4% only). This might be, at least partially, attributed to the controversy regarding the validity of these recommendations. Conversely to previous report, age does not seem to have an impact on the changes in PSA screening. Likewise, PSA screening seems to drop equally in White and Black men. This last finding might be worrisome, given that the 2012 USPSTF recommendations were mainly based on the PLCO trial, in which only 4% of the population was Black.

Funding

none