XXXX Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations.

@entity1 @entity263 @entity5 @entity1486
Importance: @entity263 incidence in @entity1 75 years and older substantially decreased following the 2008 US Preventive Services Task Force (USPSTF) recommendation against @entity1486 (PSA)-based screening for this age group. It is unknown whether incidence has changed since the USPSTF recommendation against screening for all @entity1 in May 2012. Objective: To examine recent changes in stage-specific @entity263 incidence and PSA screening rates following the 2008 and 2012 USPSTF recommendations. Design and Settings: Ecologic study of age-standardized @entity263 incidence (newly diagnosed cases/100   000 @entity1 aged >= 50 years) by stage from 2005 through 2012 using data from 18 population-based Surveillance, Epidemiology, and End Results (SEER) registries and PSA screening rate in the past year among @entity1 50 years and older without a history of @entity263 who responded to the 2005 (n   =   4580), 2008 (n   =   3476), 2010 (n   =   4157), and 2013 (n   =   6172) National Health Interview Survey (NHIS). Exposures: The USPSTF recommendations to omit PSA-based screening for average-risk @entity1 . Main Outcomes and Measures: @entity263 incidence and incidence ratios (IRs) comparing consecutive years from 2005 through 2012 by age (>= 50, 50-74, and >= 75 years) and SEER summary stage categorized as local/regional or distant and PSA screening rate and rate ratios (SRRs) comparing successive survey years by age. Results: @entity263 incidence per 100   000 in @entity1 50 years and older (N   =   446   009 in SEER areas) was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012; rates began decreasing in 2008 and the largest decrease occurred between 2011 and 2012, from 498.3 (99% CI, 492.8-503.9) to 416.2 (99% CI, 411.2-421.2). The number of @entity1 50 years and older diagnosed with @entity263 nationwide declined by 33   519, from 213   562 @entity1 in 2011 to 180   043 @entity1 in 2012. Declines in incidence since 2008 were confined to local/regional-stage disease and were similar across age and race/ethnicity groups. The percentage of @entity1 50 years and older reporting PSA screening in the past 12 months was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013. In relative terms, screening rates increased by 10% (SRR, 1.10; 99% CI, 1.01-1.21) between 2005 and 2008 and then decreased by 18% (SRR, 0.82; 99% CI, 0.75-0.89) between 2010 and 2013. Similar screening patterns were found in age subgroups 50 to 74 years and 75 years and older. Conclusions and Relevance: Both the incidence of @entity5 and rates of PSA screening have declined and coincide with 2012 USPSTF recommendation to omit PSA screening from routine primary care for @entity1 . Longer follow-up is needed to see whether these decreases are associated with trends in mortality.
