ASCO 2017: Clinical implications of the 2012 US Preventive Services Task Force PSA screening recommendation in prostate cancer diagnoses and 5-year survival at a Minnesota safety net health care system

Chicago, IL ( Prostate specific antigen (PSA) screening for prostate cancer has declined following the US Preventative Services Task Force (USPSTF) 2012 recommendation. No data exists regarding how screening rates and prostate cancer diagnoses have subsequently changed in a racially diverse patient population. Dr. Kevin Gale presented a study aiming to determine the impact of the USPSTF screening recommendation in the Hennepin Healthcare System (HHS) in the state of Minnesota.

This was a single-institution retrospective analysis of data from the authors’ center electronic health record, identifying the characteristics of PSA screening and new prostate cancer diagnoses for men ≥50 years between 2008 and 2015. Data before and after May 2012 were compared. 

Nearly 22,000 patients underwent PSA screening from 2008 to 2015. PSA screening rates decreased after May 2012 for the four largest demographics represented (p < 0.001). Hispanics and Blacks were more likely to be screened when compared to Whites and Asians (p < 0.05). 319 cases of prostate cancer were diagnosed from 2008 to 2015 with 87 cases (27.3%) diagnosed by PSA-screening. The number needed to diagnose one patient with prostate cancer at HHS was 137.5, and 9.5% of patients (1146 patients) had a false positive PSA that led to further testing or a biopsy. $56,090 was spent in screening costs per diagnosis of early stage prostate cancer via screening. Patients diagnosed from screening were less likely to present with high Gleason scores (8-10) compared to non-screening diagnosis (8% vs 23.3%, p < 0.01). The 5-year survival percentage (prostate cancer mortality) was improved for those patients diagnosed by PSA screening vs. the non-screened group (100% vs 89.3%, p < 0.05).  

In conclusion, PSA screening has declined at HHS since the USPSTF recommendation against prostate cancer screening in 2012. Implementation of PSA screening in the authors’ healthcare system was expensive and lead to a high number of false positives. However, the 5-year survival from prostate cancer is significantly higher when patients are diagnosed by PSA screening.

Presented By: Kevin Gale, Hennepin County Medical Center, Minneapolis, MN

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Twitter: @GoldbergHanan

at the 2017 ASCO Annual Meeting - June 2 - 6, 2017 - Chicago, Illinois, USA