Impact of the U.S. Preventive Services Task Force Recommendations against XXXX Screening on Prostate Biopsy and Cancer Detection Rates.

@entity5 @entity1 @entity263 @entity1486
PURPOSE: We determined if the USPSTF recommendation against @entity1486 screening was associated with a change in biopsy and @entity5 detection rates. MATERIALS AND METHODS: We conducted a time series analysis (October 2008 to  June 2013) of prostate biopsies performed at University Health Network (Toronto). Biopsies for active surveillance or solely targeting magnetic resonance imaging detected lesions were excluded from study. Interventional ARIMA models  with step functions were used to examine changes in the number of biopsies performed and @entity5 detected per month. @entity263 was defined as no Gleason pattern 4 or greater, 3 or fewer cores involved, or 1/3 or less of the total number of cores involved, and no core with greater than 50% @entity5 involvement. Intermediate to high grade @entity263 was defined as Gleason 7-10. RESULTS: A total of 3,408 biopsies were performed and 1,601 (47.0%) @entity263 were detected (low risk @entity263 563 [16.5%], intermediate to high  grade @entity263 914 [26.8%]). The median number of biopsies per month decreased from 58.0 (IQR 54.5-63.0) before the recommendations to 35.5  (IQR 27.0-41.0) afterward (p=0.003), while the median number of @entity1 undergoing first-time biopsy decreased from 42.5 (IQR 37.5-45.5) to 24.0 (IQR 19.0-32.5, p=0.025). The median number of @entity263 detected per month decreased from 8.5 (IQR 6.5-10.5) to 5.5 (IQR 4.0-7.0, p=0.012), while the median number of intermediate to high @entity263 per month decreased from 17.5 (IQR 14.5-21.5) to 10.0 (IQR 9.0-12.0, p <0.001). CONCLUSIONS: After the USPSTF recommendation the number of biopsies performed (total and first-time), based on referrals from our catchment area, has decreased. This is likely due to decreased use of @entity1486 screening. Although it is encouraging that fewer @entity263 are being diagnosed, the sudden decrease in the detection rate of @entity263 is concerning.
