title: Impact of the 2012 United States Preventive Services Task Force statement on prostate-specific antigen screening: analysis of urologic and primary care practices.
abstract: OBJECTIVE
  To identify the effect of the 2012 United States Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) recommendation statement on primary care referral patterns and urologists' decision making.
  
  
  METHODS
  Men referred to our institution for newly elevated PSA level from June 2011 to June 2013 were identified. Patients with a prior history of prostate cancer or biopsy were excluded. Clinical and management parameters were compared between those presenting in the year before vs the year after the USPSTF statement. Factors predictive of receiving a prostate biopsy were identified using multivariate regression analysis.
  
  
  RESULTS
  A total of 201 men were identified in the pre-USPSTF period and 212 men, thereafter. The groups were comparable in age, race, prostate cancer family history, PSA values, and digital rectal examination findings. At the initial evaluation, patients presenting after the statement were more likely to undergo PCA3 testing (27% vs 11%; P <.01) and repeat PSA testing (82% vs 72%; P = .02) and less likely to undergo immediate biopsy (16% vs 24%; P = .03). The proportion of patients ultimately receiving a biopsy was equivalent. The groups were similar in the percentage of positive biopsies, Gleason distribution, and D'Amico risk. African American race and family history were predictors for receiving a biopsy in the post-USPSTF group but not in the pre-USPSTF group.
  
  
  CONCLUSIONS
  The 2012 USPSTF recommendation statement has not affected the number or clinical characteristics of patients referred to a tertiary center for elevated PSA level. After recommendation, urologists ordered significantly more PCA3 and repeat PSA tests and recommended fewer biopsies at the initial visit. The fraction of patients ultimately receiving a biopsy remained the same.
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: perez.tomy@gmail.com.
authors.forename: Tomy Y
authors.initials: TY
authors.lastname: Perez
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Danzig
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Rashed A
authors.initials: RA
authors.lastname: Ghandour
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D055088:Early Detection of Cancer / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services; D011320:Primary Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014572:Urology
chemical_list: D017430:Prostate-Specific Antigen