OBJECTIVE - To determine whether the rates of 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 ages 40 years and older and without a 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 ages 75 years and older beginning in 2008, followed by 49% in ages 65-74, 20% in ages 50-64 and 33% in ages 40-49 in 2009. However, the number of elevated PSA tests remained largely unchanged in all groups except men ages 75 years and older (45% decrease). Prostate biopsy rates and urology visits remained consistent among elderly men.
CONCLUSIONS - Among men in this managed care setting, while there was a sharp decline in PSA testing among men ages 75 years and older 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 ages 75 years and older.
Urology. 2015 Jun 26. pii: S0090-4295(15)00587-7. doi: 10.1016/j.urology.2015.04.063. [Epub ahead of print]
Wallner LP1, Hsu JY2, Loo RK3, Palmer-Toy DE4, Schottinger JE5, Jacobsen SJ2.
1 Department of Medicine and Comprehensive Cancer Center, University of Michigan; Department of Research and Evaluation, Kaiser Permanente Southern California.
2 Department of Research and Evaluation, Kaiser Permanente Southern California.
3 Department of Urology, Southern California Permanente Medical Group.
4 Regional Reference Laboratories, Kaiser Permanente Southern California.
5 Department of Quality and Clinical Analysis, Kaiser Permanente Southern California.