Key result
Following the 2012 USPSTF recommendation against screening, the overall rate of PSA testing in the Veterans Health Administration decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001).
Why the study?
Following the 2012 USPSTF recommendation against all PSA screening for prostate cancer, PSA screening trends in the Veterans Health Administration and variations by race or age remained to be characterized.
Did the 2012 USPSTF recommendation against PSA screening reduce PSA screening rates among veterans?
Observational
Yes
Did the 2012 USPSTF recommendation against PSA screening reduce PSA screening rates among veterans?
Absolute Event Rate: 51.2% vs 63.3%
p-value: p=<.001
The 2012 USPSTF recommendation against PSA screening was associated with only a modest decrease in overall screening rates among veterans, though trends varied significantly by age.
VA PSA screening declined modestly post-2012 without racial disparity; leaves open generalizability and outcome effects outside integrated systems.
BACKGROUND: In 2012, the United States Preventative Services Task Force (USPSTF) formally recommended against all prostate-specific antigen (PSA) screening for prostate cancer. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation and to determine if PSA screening was more likely to be ordered based on a veteran's race or age. METHODS: Using the VA Corporate Data Warehouse, we created 10 annual groups of PSA-eligible men covering 2009-2018. We identified all PSA tests performed in the VA to determine yearly rates of PSA screening. All statistical tests were 2-sided. RESULTS: The overall rate of PSA testing in the VA decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 years having the highest initial rate and greatest decline (70.6% in 2009 to 48.4% in 2018, P < .001). Men aged 55-69 years had a smaller decline (65.2% in 2009 to 58.9% in 2018, P < .001) whereas the youngest men, aged 40-54 years, had an increase in PSA screening (26.2% in 2009 to 37.8% in 2018, P < .001). CONCLUSIONS: In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than one-half of the men in our study. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying ages experienced statistically significantly differences in PSA screening trends.
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Becker et al. (2020) conducted an observational in Prostate cancer screening. 2012 USPSTF recommendation against PSA screening vs. Pre-recommendation period (2009) was evaluated on Overall rate of PSA testing (p=<.001). Following the 2012 USPSTF recommendation against screening, the overall rate of PSA testing in the Veterans Health Administration decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001).
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