Abstract: PD43-12
Sources of Funding: None

Introduction

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. _x000D_

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)._x000D_

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.

Funding

None