title: Prostate cancer screening practices in a large, integrated health system: 2007-2014.
abstract: To assess prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men, and to assess primary provider variation associated with prostate cancer screening.
  
  
  
  Our study population included 160 211 men aged ≥40 years with at least one visit to a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 to December 2014. Yearly rates of screening PSA testing by primary care providers (PCPs), rates of re-screening, and rates of prostate biopsies were assessed.
  
  
  
  Annual PSA-screening testing declined from 2007 to 2014 in all age groups, as did biennial and quadrennial screening. Yearly rates declined for men aged ≥70 years, from 22.8% to 8.9%; ages 50-69 years, from 39.2% to 20%; and ages 40-49 years, from 11% to 4.6%. Overall rates were lower for African-American (A-A) men vs non-A-A men; for men with a family history of prostate cancer, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA testing did not substantially change after the USPSTF recommendations. While the number of men screened and rates of follow-up prostate cancer screening declined in 2011-2014 compared to 2007-2010, similar re-screening rates were noted for men aged 45-75 years with initial PSA levels of <1 ng/mL or 1-3 ng/mL in both the earlier and later cohorts. For men aged >75 years with initial PSA levels of <3 ng/mL screened in both cohorts, follow-up screening rates were similar. Rates of prostate biopsy declined for men aged ≥70 years in 2014 compared to 2007. For men who had PSA screening, rates of first prostate biopsy increased in later years for A-A men and men with a family history of prostate cancer.
  
  
  
  Prostate cancer screening declined from 2007 to 2014 even in higher-risk groups and follow-up screening rates were not related to previous PSA level. However, rates of first prostate biopsy in men who were screened with a PSA test were higher for men with an increased risk of prostate cancer in later years. Variation in PSA testing was noted among PCPs. Future work should further explore sources of variation in screening practices and implementation of risk-based strategies for prostate cancer screening in primary care.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.|Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Anita D
authors.initials: AD
authors.lastname: Misra-Hebert
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stephenson
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Glen B
authors.initials: GB
authors.lastname: Taksler
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.|Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen
keywords: #PCSM; #ProstateCancer; cancer screening; primary care