title: Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations.
abstract: OBJECTIVE
  Prostate cancer incidence in men 75 years and older substantially decreased following the 2008 US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)-based screening for this age group. It is unknown whether incidence has changed since the USPSTF recommendation against screening for all men in May 2012.
  
  
  OBJECTIVE
  To examine recent changes in stage-specific prostate cancer incidence and PSA screening rates following the 2008 and 2012 USPSTF recommendations.
  
  
  METHODS
  Ecologic study of age-standardized prostate cancer incidence (newly diagnosed cases/100,000 men aged ≥50 years) by stage from 2005 through 2012 using data from 18 population-based Surveillance, Epidemiology, and End Results (SEER) registries and PSA screening rate in the past year among men 50 years and older without a history of prostate cancer who responded to the 2005 (n = 4580), 2008 (n = 3476), 2010 (n = 4157), and 2013 (n = 6172) National Health Interview Survey (NHIS).
  
  
  METHODS
  The USPSTF recommendations to omit PSA-based screening for average-risk men.
  
  
  METHODS
  Prostate cancer incidence and incidence ratios (IRs) comparing consecutive years from 2005 through 2012 by age (≥50, 50-74, and ≥75 years) and SEER summary stage categorized as local/regional or distant and PSA screening rate and rate ratios (SRRs) comparing successive survey years by age.
  
  
  RESULTS
  Prostate cancer incidence per 100,000 in men 50 years and older (N = 446,009 in SEER areas) was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012; rates began decreasing in 2008 and the largest decrease occurred between 2011 and 2012, from 498.3 (99% CI, 492.8-503.9) to 416.2 (99% CI, 411.2-421.2). The number of men 50 years and older diagnosed with prostate cancer nationwide declined by 33,519, from 213,562 men in 2011 to 180,043 men in 2012. Declines in incidence since 2008 were confined to local/regional-stage disease and were similar across age and race/ethnicity groups. The percentage of men 50 years and older reporting PSA screening in the past 12 months was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013. In relative terms, screening rates increased by 10% (SRR, 1.10; 99% CI, 1.01-1.21) between 2005 and 2008 and then decreased by 18% (SRR, 0.82; 99% CI, 0.75-0.89) between 2010 and 2013. Similar screening patterns were found in age subgroups 50 to 74 years and 75 years and older.
  
  
  CONCLUSIONS
  Both the incidence of early-stage prostate cancer and rates of PSA screening have declined and coincide with 2012 USPSTF recommendation to omit PSA screening from routine primary care for men. Longer follow-up is needed to see whether these decreases are associated with trends in mortality.
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Fedewa
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Jiemin
authors.initials: J
authors.lastname: Ma
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Siegel
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Chun Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Office of Chief Medical Officer/Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Otis
authors.initials: O
authors.lastname: Brawley
authors.affiliation: Intramural Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
mesh_terms: D026683:Advisory Committees; D000367:Age Factors; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000208:ethnology; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D017430:Prostate-Specific Antigen