Since the US Preventive Services Task Force (USPSTF) issued its recommendation against prostate-specific antigen (PSA) screening in 2012, the use of PSA screening and digital rectal examinations has decreased significantly, as has the incidence of early-stage prostate cancer.
Now, a study of operative case logs from a nationally representative sample of urologists for the last 7 years shows that the rates of prostate biopsies and radical prostatectomies (RPs) performed have also decreased significantly since 2012 — by 28.7% and 16.2%, respectively.
"These findings represent the direct downstream effects of the USPSTF recommendation," say the study authors, led by Jim C. Hu, MD, MPH, of the Department of Urology at Weill Cornell Medicine, in New York City.
Dr Hu told Medscape Medical News he and his colleagues are "very concerned" about the study findings and that they did not anticipate "the rapidity of the drop in both procedures nor the magnitude of the decrease."
Their report was published online November 2 in JAMA Surgery.
"While the pendulum of prostate cancer screening continues to swing, a more extended vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation with regard to stage at presentation, outcomes following treatment, and disease-specific mortality in prostate cancer," the study authors suggest.
Four years ago, the USPSTF's recommendation for routine PSA screening for men younger than 75 years was downgraded from a class C to a class D recommendation, effectively taking it off the table. Now that recommendation is being revised, Dr Hu and colleagues note.
Policy makers need to "weigh the downstream effects of the 2012 USPSTF recommendation and consider future unintended consequences," they say.
For the study, the American Board of Urology provided case logs from 5270 urologists applying for certification or recertification from 2009 through 2016. Procedural volumes were validated with biopsy volumes from New York State; RP volumes were valided from the Nationwide Inpatient Sample.
The total number of annual biopsies decreased by 12.7% following the USPSTF recommendation, the study showed, a finding consistent with other, single-institution studies.
The greatest decrease in biopsy volume was seen in biopsies performed when the patient had an abnormal PSA test result (26.7%). At the same time, the number of biopsies performed for cancer surveillance increased by 28.8%, the study revealed.
Declines in biopsy volume were greatest in communities with populations fewer than 100,000.
Male urologists appeared to be responsible for much of the higher biopsy volume; the volume of biopsy was lower for clinicians with a specialty in oncology.
The decrease in RP volume for prostate cancer following the USPSTF recommendation is a unique finding, the researchers point out.
For clinicians who were certified after 2012, RP volume was lower; for male urologists and clinicians with an oncologic subspecialty, RP volume was higher.