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Decline in PSA Testing

November 2015

        The Washington Post (11/18, Bernstein) reports on two studies published in JAMA finding that in the wake of a finding by the US Preventive Services Task Force in 2012 that the prostate-specific antigen test “causes more harm than good,” that the number of tests and the number of prostate cancer diagnoses “have both declined sharply.” With testing of men 50 and older falling from 40.6 percent in 2008 to 30.8 percent in 2013, and prostate cancer diagnoses falling to 416.2 per 100,000 in 2012 from 534.9 per 100,000 in 2005.

        The New York Times (11/18, Grady, Subscription Publication) reports that in one of the studies, the authors said that the decline in testing and diagnoses “could have significant public health implications,” but that it was not yet clear whether they would have an effect on death rates. JAMA also contains an editorial by Dr. David F. Penson, chairman of urologic surgery at Vanderbilt University Medical Center, arguing that it may be time to reconsider the role of testing and urged a move to “smarter” screening by “focusing more on those at high risk.” In one study, American Cancer Society researchers focused on the decline in “early-stage diagnoses of prostate cancer” which they attributed to the decline in testing. The second study “also found a significant decline in PSA testing” in relation to the USPSTF recommendation.

        The Wall Street Journal (11/18, Beck, Subscription Publication) reports that the American Urological Association recommends that physicians discuss screening with their patients and let patients decide how to proceed.

        The AP (11/18, Tanner) reports that it is projected that over 27,000 US men will die from prostate cancer this year. Lead author of the first study, American Cancer Society researcher Ahmedin Jemal pointed out that “there’s no way to know which early-stage tumors will grow to become lethal.” As a result, said Jemal, “We may be reducing overdiagnosis and overtreatment ... but we also may be missing opportunities to detect” dangerous cancers.

        Reuters (11/18, Seaman) reports that chief medical officer for the American Cancer Society Dr. Otis Brawley commented, “I’m hoping that men are being allowed to make a choice and this decline reflects the fact that they prefer not to be screened.”

        NPR (11/18, Stein) reports in its “Shots” blog that the studies “don’t settle” the question of whether the USPSTF recommendation was sound, “but they do shed light on the effect” in that they show a decline in both screening and diagnoses. Dr. Brawley said the studies show “the American public actually did listen” to the recommendation.

        Stat (11/18, Begley) reports that critics of screening “have finally gotten what they wanted,” but that raises the question: “will more men die of prostate cancer?” Dr. Penson argues in his editorial that the answer is “yes,” calculating that “1,241 more men” will die of prostate cancer because of the decline in screening. Yet, Georgetown University’s Dr. Kenneth Lin pointed out that previous studies “did not show the blood test saves men’s lives.”

        TIME (11/18, Park) notes that “the American Urological Association currently supports doctors discussing the need for PSA testing with their patients starting at age 55.”

        Modern Healthcare (11/17, Robeznieks, Subscription Publication) reports that “the American Urological Association and the American College of Physicians internal medicine society issued guidelines recommending against screening in most cases.”

        HealthDay (11/18, Norton) and Medscape (11/18, Lowry) also report on the story.

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