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PSA screening, prostate biopsy, and treatment of prostate cancer in the years surrounding the USPSTF recommendation against prostate cancer screening
Author(s) -
Kearns James T.,
Holt Sarah K.,
Wright Jonathan L.,
Lin Daniel W.,
Lange Paul H.,
Gore John L.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31337
Subject(s) - medicine , prostate cancer , prostate , prostate biopsy , prostate cancer screening , cancer , incidence (geometry) , biopsy , gynecology , prostate specific antigen , overdiagnosis , confidence interval , urology , oncology , physics , optics
BACKGROUND The 2012 United States Preventive Services Task Force recommendation against screening for prostate cancer has impacted rates of prostate‐specific antigen (PSA) screening and appears to be associated with declining prostate cancer incidence. Our objective was to characterize health care utilization that may explain these observed trends. METHODS MarketScan claims, which capture >30 million privately insured patients in the United States, were queried for all men aged 40‐64 years for the years 2008‐2014. PSA testing, prostate biopsy, prostate cancer diagnosis, and definitive local treatment were determined using associated International Classification of Diseases, Ninth Revision and Current Procedural Terminology, Fourth Edition codes. RESULTS There were approximately 6 million qualifying men with a full year of data. PSA testing, prostate biopsy, and prostate cancer detection declined significantly between 2009 and 2014, most notably after 2011. The prostate biopsy rate per 100 patients with a PSA test decreased over the study period from 1.95 (95% confidence interval [CI], 1.92‐1.97) to 1.52 (95% CI, 1.50‐1.54). Prostate cancer incidence per prostate biopsy increased over the study period from 0.36 (95% CI, 0.35‐0.36) to 0.39 (95% CI, 0.39‐0.40). Of new prostate cancer diagnoses, the proportion managed with definitive local treatment decreased from 69% (95% CI, 69%‐70%) to 54% (95% CI, 53%‐55%). Both PSA testing and prostate cancer incidence decreased significantly after 2011 ( P < .001). CONCLUSION In a large cohort of privately insured men, PSA testing, prostate biopsy, prostate cancer incidence, and local definitive treatment for prostate cancer decreased between 2008 and 2014, most notably after 2011. This decrease may be driven by differential referral patterns from primary care providers to urologists. Cancer 2018;124:2733‐2739 . © 2018 American Cancer Society