title: Primary care physician PSA screening practices before and after the final U.S. Preventive Services Task Force recommendation.
abstract: OBJECTIVE
  In May 2012, United States Preventive Services Task Force (USPSTF) finalized its recommendation against prostate-specific antigen (PSA) screening in all men. We aimed to assess trends in PSA screening frequency amongst primary care physicians (PCPs) surrounding the May 2012 USPSTF recommendation.
  
  
  METHODS
  The electronic data warehouse was used to identify men aged between 40 and 79 years with no history of prostate cancer or urology visit who were evaluated by an internal medicine or family practice physician between 2007 and 2012. Analyses were directed toward PSA testing within 6-month time period from June to November, with particular focus on the 2011 (pre-USPSTF recommendation) and 2012 (post-USPSTF recommendation) cohorts. The primary outcome measure was proportion of men with at least 1 PSA test during the 6-month pre- and post-USPSTF recommendation periods.
  
  
  RESULTS
  A total of 112,221 men met inclusion criteria. There was a significant decrease in screening frequency between the 2011 and 2012 cohorts (8.6% vs. 7.6%, P = 0.0001; adjusted odds ratio 0.89, 95% confidence interval 0.83-0.95). This decrease was most evident amongst patients aged 40 to 49 years (5.6% vs. 4.6%, P = 0.004) and 70 to 79 years (7.9% vs. 6.2%, P = 0.01). A significant decrease was also observed in patients with highest previous PSA value<1.0 (P<0.0001) and 1.0 to 2.49 ng/ml (P = 0.0074).
  
  
  CONCLUSIONS
  Since the USPSTF recommendation was finalized, there is evidence of continuing decreases in PSA testing by PCPs. PCPs may be shifting toward more selective screening practices, as decreases in screening are most pronounced in the youngest and oldest patients and in those with history of PSA values<2.5 ng/ml.
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cohn
authors.affiliation: Center for Clinical and Research Informatics, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Chihsiung E
authors.initials: CE
authors.lastname: Wang
authors.affiliation: Center for Clinical and Research Informatics, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Lakeman
authors.affiliation: Center for Clinical and Research Informatics, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Silverstein
authors.affiliation: Division of Urology, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Brendler
authors.affiliation: Division of Urology, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Kristian R
authors.initials: KR
authors.lastname: Novakovic
authors.affiliation: Division of Urology, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Michael S
authors.initials: MS
authors.lastname: McGuire
authors.affiliation: Division of Urology, NorthShore University HealthSystem, Evanston, IL. Electronic address: bhelfand@northshore.org.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Helfand
mesh_terms: D000328:Adult; D026683:Advisory Committees / Q000592:standards; D000368:Aged; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D013997:Time Factors; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen
keywords: Primary care; Prostate-specific antigen; Screening; United States Preventive Services Task Force