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A slight decrease in the use of PSA testing since early 2009

Posted Mar 24 2011 12:00am

Apparently, in the USA,  there has been a small decrease in the incidence of PSA testing since the publication of data from the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) and European Randomized Study of Screening for Prostate Cancer (ERSCP) trials back in March 2009.

The PCLO trial showed no difference in mortality between screening and control groups; by contrast the ERSCP trial reported a 20 percent reduction in prostate cancer-specific mortality among the screening group. The detailed results of these two trials have been previously (and extensively) discussed.

Zeliadt et al. wanted to determine whether the application of PSA testing had changed following publication of the initial results of these two articles. To discover this, they set out to assess the proportion of male patients seen at least once at a primary care or urology clinic between August 1, 2004, and March 31, 2010, who received a PSA test.

They were able to show the following:

  • Since publication of the two articles in the March 29, 2009 issue of the New England Journal of Medicine

The authors were also able to show that:

  • PSA use among men > 75 years initially declined slightly following the issue of recommendations by the US Preventive Services Task Force in 2008 (that PSA testing was generally inappropriate for men > 75 years of age).
  • PSA use among men > 75 years continued to decline after publication of the results of the two major screening trials.

However, the available abstract of this paper does not give specific numbers for the decline in use of PSA testing among men > 75 years of age.

The abstract of this paper also provides no information about why there have been these declines in the use of the PSA test. Is it because men are asking for the PSA test less often or is it because their doctors are recommending the test less frequently? We are given no data in the abstract, and there may be none in the full paper either. (We have requested a copy of the entire paper from the authors in order to be bale to better assess the implications of this paper.)

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