PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes

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  • a Stanford University School of Medicine;
  • b Stanford School of Medicine, IRT Research Technology;
  • c Department of Medicine, Stanford University;
  • d Stanford Cancer Institute; and
  • e Department of Urology and
  • f Department of Biomedical Data Science, Stanford University, Stanford, California.
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Background: Most patients with prostate cancer are diagnosed with low-grade, localized disease and may not require definitive treatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening to address overdetection and overtreatment. This study sought to determine the effect of guideline changes on prostate-specific antigen (PSA) screening and initial diagnostic stage for prostate cancer. Patients and Methods: A difference-in-differences analysis was conducted to compare changes in PSA screening (exposure) relative to cholesterol testing (control) after the 2012 USPSTF guideline changes, and chi-square test was used to determine whether there was a subsequent decrease in early-stage, low-risk prostate cancer diagnoses. Data were derived from a tertiary academic medical center’s electronic health records, a national commercial insurance database (OptumLabs), and the SEER database for men aged ≥35 years before (2008–2011) and after (2013–2016) the guideline changes. Results: In both the academic center and insurance databases, PSA testing significantly decreased for all men compared with the control. The greatest decrease was among men aged 55 to 74 years at the academic center and among those aged ≥75 years in the commercial database. The proportion of early-stage prostate cancer diagnoses (<T2) decreased across age groups at the academic center and in the SEER database. Conclusions: In primary care, PSA testing decreased significantly and fewer prostate cancers were diagnosed at an early stage, suggesting provider adherence to the 2012 USPSTF guideline changes. Long-term follow-up is needed to understand the effect of decreased screening on prostate cancer survival.

Submitted September 15, 2018; accepted for publication January 15, 2019.

Author contributions: Study concept and design: All authors. Data acquisition, analysis, or interpretation: Magnani, Seto, Hernandez-Boussard. Statistical analysis: Magnani, Hernandez-Boussard. Administrative, technical, or material support: Hernandez-Boussard. Supervision: Hernandez-Boussard. Drafting of manuscript: Magnani. Critical revision: All authors.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Tina Hernandez-Boussard, PhD, MPH, MS, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305-5479. Email:

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