title: Trends in Prostate-specific Antigen Screening, Prostate Biopsies, Urology Visits, and Prostate Cancer Treatments From 2000 to 2012.
abstract: OBJECTIVE
  To determine whether the rates of prostate-specific antigen (PSA) screening, related biopsies and subsequent prostate cancer utilization decreased between 2000 and 2012 in a large, managed care organization.
  
  
  METHODS
  Male members of Kaiser Permanente Southern California who were aged ≥40 years and had no history of prostate cancer (N = 15,326) were passively followed through electronic health plan files from January 1, 2000, through December 31, 2012 (N = 1,539,469). The rates of PSA testing, elevated PSA tests, prostate biopsies, prostate cancer treatment (surgery and radiation), and urology visits were calculated per year among eligible men and stratified by age group.
  
  
  RESULTS
  A 59% decrease in PSA screening occurred among men aged ≥75 years beginning in 2008, followed by 49% in ages 65-74, 20% in ages 50-64, and 33% in ages 40-49 years in 2009. However, the number of elevated PSA tests remained largely unchanged in all groups except in men aged ≥75 years (45% decrease). Prostate biopsy rates and urology visits remained consistent among elderly men.
  
  
  CONCLUSIONS
  Among men in this managed care setting, although there was a sharp decline in PSA testing among men aged ≥75 years after 2008, prostate biopsy rates remained constant, and subsequent prostate cancer treatment remained highest among men in this age group. These results suggest that the guidelines recommending against PSA and the subsequent provider-targeted interventions implemented in this system resulted in decreased screening across age groups and potentially led to more discriminant screening among those aged ≥75 years.
authors.affiliation: Department of Medicine and Comprehensive Cancer Center, Institute for Healthcare Policy and Innovation, University of Michigan; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: lwallner@med.umich.edu.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Wallner
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Jin-Wen Y
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Department of Urology, Southern California Permanente Medical Group, Pasadena, CA.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Loo
authors.affiliation: Regional Reference Laboratories, Kaiser Permanente Southern California, Los Angeles, CA.
authors.forename: Darryl E
authors.initials: DE
authors.lastname: Palmer-Toy
authors.affiliation: Department of Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Schottinger
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data*; D002140:California; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*
chemical_list: D017430:Prostate-Specific Antigen