1245 THE IMMEDIATE IMPACT OF US PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS ON PSA SCREENING BEHAVIORS OF PRIMARY CARE PHYSICIANS

You have accessJournal of UrologyProstate Cancer: Detection & Screening (I)1 Apr 20131245 THE IMMEDIATE IMPACT OF US PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS ON PSA SCREENING BEHAVIORS OF PRIMARY CARE PHYSICIANS Joshua Cohn, Justin Lakeman, Eric Brown, Jonathan Silverstein, Charles Brendler, Michael McGuire, and Brian Helfand Joshua CohnJoshua Cohn Chicago, IL More articles by this author , Justin LakemanJustin Lakeman Evanston, IL More articles by this author , Eric BrownEric Brown Evanston, IL More articles by this author , Jonathan SilversteinJonathan Silverstein Evanston, IL More articles by this author , Charles BrendlerCharles Brendler Evanston, IL More articles by this author , Michael McGuireMichael McGuire Evanston, IL More articles by this author , and Brian HelfandBrian Helfand Evanston, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In May 2012, the United States Preventive Services Task Force (USPSTF) released its final recommendation against prostate specific antigen (PSA) screening in all men. The immediate impact of this recommendation on PSA testing in a primary care setting is unknown. METHODS NorthShore University HealthSystem Enterprise Data Warehouse was used to compare the frequency of PSA testing by primary care physicians. Eligibility criteria: men aged 40-79 years evaluated by Internal Medicine or Family Practice, no history of prostate cancer or urologic referral. Baseline characteristics including age, prior PSA, ethnicity, and insurance were documented. The proportion of men with at least one PSA test over a 5 month period was compared between two cohorts: pre-USPSTF recommendations (6/2011-10/2011) and post recommendations (6/2012-10/2012). Chi-squared analysis was used for comparison of proportions. Given the large study population, a more conservative Bayes Factor (ratio of likelihood of null hypothesis to likelihood of alternative) was calculated to assist interpretation of differences in screening between the two cohorts. RESULTS The study population was comprised of 41,171 men: 18,399 in the pre-recommendation (2011) cohort and 22,772 in the post-recommendation (2012) cohort. The pre-USPSTF cohort was significantly younger (32.4 vs. 30.3% aged 40-49, p<0.001) and less likely to be insured by Blue Shield (35.5 vs. 37.4%, p<0.001) (Table 1, left side). Bayes Factor analysis substantially favored a decrease in overall screening (7.9 vs. 6.9%, p<0.001) and appeared to be most evident in men aged 70-79 (9.1 vs. 5.6%, p<0.001), Caucasians (9.2 vs. 7.7%, p<0.001), and those with prior highest PSA <2.5 ng/dL (10.5 vs. 8.5%, p<0.001) (Table 1, right side). Of the 9,764 patients present in both cohorts, 844 (8.6%) underwent screening in the 2011 cohort vs. 759 (7.8%) in the 2012 cohort (p=0.03). CONCLUSIONS In the short time interval since the USPSTF recommendations were finalized, there is already evidence of decreased PSA screening. The recommendations may be associated with more selective screening practices, as indicated by a significant decrease in screening frequency within the oldest patients and in those without a history of an elevated PSA. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e509 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Joshua Cohn Chicago, IL More articles by this author Justin Lakeman Evanston, IL More articles by this author Eric Brown Evanston, IL More articles by this author Jonathan Silverstein Evanston, IL More articles by this author Charles Brendler Evanston, IL More articles by this author Michael McGuire Evanston, IL More articles by this author Brian Helfand Evanston, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...