title: The impact of recent screening recommendations on prostate cancer screening in a large health care system.
abstract: OBJECTIVE
  The United States Preventive Services Task Force recently recommended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommendation on prostate cancer screening in a large health system.
  
  
  METHODS
  We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affiliated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology).
  
  
  RESULTS
  A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar patterns were noted in almost all subgroups. The greatest decrease in screening was observed by urologists and in patients in the intermediate age group (50 to 59 years).
  
  
  CONCLUSIONS
  United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy.
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Afshin
authors.initials: A
authors.lastname: Aslani
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Minnillo
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ben
authors.initials: B
authors.lastname: Johnson
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cherullo
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Ponsky
authors.affiliation: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: robert.abouassaly@uhhospitals.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
mesh_terms: D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: mass screening; practice guidelines as topic; prostate; prostate-specific antigen; prostatic neoplasms