Millions of Men Screened for Prostate Cancer Despite Evidence to Stop

Despite the fact that the U.S. Preventive Services Task Force (USPSTF) has recommended against using prostate-specific antigen (PSA) testing, physicians continue to use this as a method to screen men for prostate cancer in the U.S.

According to a review of data on 92 million men presented recently by Centers for Disease Control and Prevention (CDC) researcher Shahram Shahangian, Ph.D., the impact of the recommendations has been “very modest,” with a roughly 10% decline in utilization since the Task Force’s 2008 recommendation against use of PSA-based screening for prostate cancer in men younger than 50 and older than 74. (In 2012, the Task Force revised its recommendations, urging against any PSA-based screening.)

Beyond this modest overall decline in PSA-based screening, “the fact that testing continues in the older population, where there should not be any testing done, is very disappointing,” Dr. Shahangian told Medscape.

It’s interesting to note some groups believe there is still a limited role for PSA screening. For example, the American Urological Association recommends offering PSA screening to men 50 to 69 years old who have a minimum of 10 remaining years of life expectancy, as long as there is informed consent and shared decision making between the health care provider and patient.

Dr. Yair Lotan of University of Texas Southwestern’s Harold C. Simmons Comprehensive Cancer Center told Urology Times, “One of the problems is if you follow the U.S. Preventive Services Task Force recommendation against PSA screening and don’t even discuss it with patients, you are not giving your patient the important option of screening. You have to be honest about discussing the pros and cons and help inform patients about the value of PSA testing.”

Why does the U.S. health care system continue to reimburse for testing that is no longer based on the latest evidence?

When the evidence does not support a health care intervention, who should pay? When a patient is warned PSA screening is no longer recommended, as suggested by Dr. Lotan as part of shared decision making, but the patient wants the screening anyway, should they have to pay for it?

There is a relatively easy fix for this persistence of non-recommended testing; both public and private payers could simply stop reimbursing for the test. However, cases like this point to a broader question: who gets to decide whether and when a widely used and accepted practice, particularly in oncology, should no longer be paid for?