The U.S. Preventive Services Task Force (USPSTF), an independent national panel of medical experts, this week released a draft revised guideline on screening for prostate cancer with the prostate-specific antigen (PSA) test. The revised guideline reverses its 2012 recommendation discouraging PSA screening among men of all races and ages. Instead, USPSTF now encourages men ages 55 to 69 to discuss the test with their physicians and decide for themselves if they want to undergo PSA screening. The draft guideline also recommends against PSA screening in men 70 and older.
Prior to 2012, the USPSTF could not recommend for or against PSA screening in men younger than 75 due to insufficient scientific evidence on the benefits and harms of screening. The USPSTF based its 2012 recommendation on scientific evidence from two large clinical trials indicating that false positives, unnecessary treatment, and harmful side effects such as incontinence and impotence outweighed the benefits.
White men experienced largest decline in PSA screening
To see what happened to PSA screening rates during this period of changing clinical guidelines, we calculated PSA screening rates among men 50 and older using the OptumLabs™ Data Warehouse (OLDW), a comprehensive, longitudinal, real-world data asset with de-identified lives across claims and clinical information.
An AARP Public Policy Institute Spotlight report released today found PSA screening rates between 2009 and 2014 differed considerably by race and ethnicity, with the largest declines occurring in white men.
Among men ages 50 to 64, PSA screening decreased 18 percent in whites (41 percent to 33 percent), 14 percent in Hispanics (38 percent to 33 percent), and 13 percent in Asians (42 percent to 37 percent). PSA screening rates among black men remained unchanged at 42 percent.
Among men age 65 and older, PSA screening rates declined in only two of four racial and ethnic groups. While rates dropped among blacks (6 percent drop; 35 percent to 33 percent) and whites (20 percent drop; 33 percent to 27 percent), they rose in Asians (39 percent to 42 percent) and Hispanics (34 percent to 35 percent).
While our analyses cannot determine the reasons behind these differences, our findings suggest that many men, especially nonwhites, were already engaging in individualized decision making about PSA screening.
More research inclusion, transparency needed
The USPSTF based its 2012 recommendation on evidence from trials conducted predominantly among white men. Given the new focus on individualized decision making, researchers must ensure that men of all races and ethnicities are included in PSA screening clinical trials in order to generate robust data upon which to make appropriate recommendations.
In the meantime, it is essential to improve transparency around the clinical data that support clinical guidelines.
Physicians will need training in how best to communicate the most current scientific evidence on the risks and benefits of screening tests to different racial and ethnic groups in order to improve the alignment between patient values, screening decisions and treatment options.