Yale Cancer Center Study Shows Rates of PSA Testing for Prostate Cancer Increased After Revised National Guidelines

In a large study led by Yale Cancer Center, more men received a prostate-specific antigen or PSA test to detect prostate cancer following revisions to the recommendation by the U.S. Preventative Services Task Force (USPSTF) on screening. The results also showed significant increases in PSA testing among older men, a group for whom screening is not routinely recommended. The findings will be published online today in the journal JAMA Oncology.

“The findings from our study are intriguing. Increases in PSA testing were expected based on renewed support the consideration of screening from the USPSTF. These findings underscore the importance of screening guidelines from the task force and the rapid responsiveness of clinicians and patients,” said Michael S. Leapman, MD, Assistant Professor of Urology, Clinical Program Leader of the Prostate and Urologic Cancers Program at Smilow Cancer Center, and Yale Cancer Center and lead author of the study. “However, increases in all age groups, including those for whom screening is not recommended, also highlight challenges to achieving a nuanced, evidence-based national approach to screening.”

According to the American Cancer Society, close to 250,000 men will be diagnosed with prostate cancer in the U.S. this year, with more than 34,000 deaths. Prior guidance from the USPSTF in 2012 discouraged prostate cancer screening in all patients and led to reduced national rates of PSA testing and early detection of the disease. But in a 2017 draft statement, the USPSTF reversed its 2012 guidance advising against PSA screening for prostate cancer in all men, instead endorsing individual decision-making for men aged 55 to 69 years. The agency recommends against PSA-based testing for men aged 70 years or older.

In this retrospective cohort study, researchers accessed claims data from BCBS Axis of more than eight million Blue Cross Blue Shield beneficiaries from 2016-2019. The results showed a relative 12.5 percent increase in rates of PSA testing in men aged 40 to 89 years. The relative increase among men aged 55 to 69 years, for whom screening is specified by the guideline, was 12.1 percent. PSA testing rates increased a relative 10.1 percent among men aged 40 to 54 years and 16.2 percent for men aged 70 years or older, for whom screening is not recommended.

“The consequences of increased PSA testing remain to be appreciated,” added Xiaomei Ma, PhD, Professor of Epidemiology, Co-Leader of the Cancer Prevention and Control Research Program at Yale Cancer Center, and senior author of the study. “Further study is needed to better understand patient perspectives and potential quality of life implications for both younger and older men.”

Other Yale authors contributing to this research include: Rong Wang, PhD, Henry Park, MD, MPH, James Yu, MD, MHS, Preston Sprenkle, MD, and Cary Gross, MD.