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Prostate cancer screening has declined in older men following guideline revisions
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Prostate cancer screening rates significantly decreased among men aged 50 years or older since the release of a U.S. Preventive Services Task Force guideline that discouraged PSA-based screening in asymptomatic men, according to study results.
Still, a significant proportion of men — including one-third of men aged 75 years or older — continue to receive prostate cancer screening despite having a high 9-year mortality risk, the researchers also found.
The U.S. Preventive Services Task Force (USPSTF) revised their prostate cancer screening guidelines in 2012 to discourage PSA-based prostate cancer screening in asymptomatic men. The 2008 recommendations had emphasized limited screening recommendations to men with a life expectancy of 10 years or more and discouraged screening in men aged 75 years or older. However, screening rates among men aged older than 65 years did not greatly change before and after these recommendations, according to study background.
Scott E. Eggener
Scott E. Eggener, MD, associate professor of surgery and co-director of the Prostate Cancer Program at the University of Chicago Medical Center, and colleagues conducted a population-based trend analysis to determine the impact of the 2012 USPSTF recommendations. Researchers used data collected from the National Health Interview Survey to estimate the percentage of men screened for prostate cancer in 2013 and an externally validated 9-year mortality index to determine screening rates based on life expectancy. Logistic regression compared screening rates from 2005, 2010 and 2013.
The analysis excluded men aged younger than 40 years and men with a history of prostate cancer.
Among men aged 40 to 49 years, PSA-based screening rates did not significantly change between 2010 and 2013 (12.5% vs. 11.2%). However, significant declines in screening rates occurred among men aged 50 to 59 years (33.2% vs. 24.8%; P < .01), 60 to 74 years (51.2% to 43.6%; P < .01) and 75 years or older (43.9% vs. 37.1%; P = .03).
Men aged 65 years or older in 2013 underwent screening less frequently if they were less healthy and had an elevated (> 52%) 9-year mortality risk (OR = 0.48). This association persisted among men aged 65 to 69 years (OR = 0.38), 70 to 74 years (OR = 0.44) and 75 years or older (OR = 0.62).
However, approximately 1.4 million men aged 65 years or older with an elevated (> 52%) 9-year mortality risk still underwent prostate cancer screening in 2013, which included 27.2% of men aged 65 to 69 years, 32.3% of men aged 70 to 74 years, and 32.3% of men aged at least 75 years.
Results of a multivariate analysis of men aged 65 years or older indicated having a college education, consuming alcohol, having received a colonoscopy with the prior 10 years, independent living, performing light or moderate activities, and favorable health significantly increased the likelihood of screening (P < .05 for all).
After accounting for mortality risk, the researchers observed an association between white race, marital status, alcohol consumption, colonoscopy receipt, active lifestyle and a lower risk for 9-year mortality with a significant increase in screening likelihood (P < .05 for all).
The researchers acknowledged the fact that the analysis was limited to men who had visited a physician within the previous year served as a limitation to these findings.
“Encouragingly, an increased probability of 9-year mortality was associated with decreased screening rates from 2010 to 2013,” Eggener and colleagues concluded. “Despite these trends, roughly a third of men older than age 65 years with a high probability of death within the next 9 years were screened for prostate cancer, exposing these approximately 1.4 million men to a high risk of overdiagnosis and overtreatment." – by Cameron Kelsall
Disclosure: Eggener reports research funding from Myriad Genetics, speakers bureau roles with Janssen Pharmaceutical and Myriad Genetics and a consultant role with Genomic Health, Janssen Pharmaceuticals, MDxHealth, Medivation, Myriad Genetics and OPKO Diagnostics. The other researchers report no relevant financial disclosures.
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