Public Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75

doi:10.1016/j.urology.2009.06.091

Urology

Volume 75, Issue 5, May 2010, Pages 1122-1127

https://doi.org/10.1016/j.urology.2009.06.091 Get rights and content

Objectives

To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75.

Methods

Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, ≥ 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and ≥ 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis.

Results

Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age ≥ 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged ≥ 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05).

Conclusions

Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged ≥ 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.

Section snippets

Public Survey

A cohort of 340 patients was surveyed at Duke University's 2008 annual free prostate cancer screening clinic. Patients were divided into 2 groups based on the awareness of the recommendations (yes, no) and educational level (non-College graduate (NCG), College graduate (CG)). Age (< 75, ≥ 75), race (African American, Caucasian), health insurance status (yes, no), self-perceived knowledge of prostate cancer (yes, no), and opinion on screening after age 75 (disagreed, agreed) were analyzed

Results

Among 340 surveyed men, 78.2% disagreed with the recommendation to discontinue prostate cancer screening in men at age 75 (Table 1). The number of men who disagreed was not significantly different between education groups (77.9% NCG, 78.5% CG, P = .868) or awareness groups (78.0%: not aware, 76.7%: aware, P = .962). Self-perceived knowledge of prostate cancer was significantly different (NCG 67.4 vs CG 90.6%, P <.001) and awareness of new screening guidelines showed a marginal difference

Comment

This study evaluated the 2008 USPSTF PSA screening recommendation by integrating a patient survey and a disease risk and outcomes analysis focusing on men aged ≥ 75 years. Approximately 73% of men surveyed in our study were not aware of and 78% disagreed with the USPSTF recommendation to discontinue PSA screening to men at age 75. The results indicated poor public awareness and understanding of the recommendation. Our disease risk and outcomes results showed that men aged ≥ 75 years were

Conclusions

Men presenting to the PSA screening clinic disagreed with the discontinuation of PSA screening at age 75. Men aged ≥ 75 years have a higher risk disease and poorer survival. The USPSTF recommendation was not supported by public opinion or our disease risk and survival analysis. The USPSTF recommendations may result in unfavorable outcomes in many men aged 75 years and older.

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Cited by (9)

Patient opinions on prostate cancer screening are swayed by the United States preventative services task force recommendations
2014, Urology
Citation Excerpt :
In the past, the public has not supported initiatives to discontinue or minimize PCa screening. According to Caire et al,9 78% of men disagreed with the 2008 USPSTF recommendation to discontinue PSA screening in men aged ≥75 years. In a similar fashion, we found that 80% of our patients continued to support PCa screening, even after reading about its limitations.
To survey patient opinions on prostate cancer (PCa) screening in light of the United States Preventive Services Task Force recommendation against its use.
We conducted a survey of all-comers to urology and primary care clinics. Participants provided demographic information and responded to a 5-item questionnaire regarding their opinions on screening before and after reading opposing position statements.
The overall response rate was 48%. After excluding incomplete questionnaires, 54 surveys were available for analysis. Patients were predominantly white, middle-aged and older, college-educated men with middle-to-upper-middle-class incomes who were seen at urology clinics. Patients rated their “pre” level of understanding of screening recommendations as good or very good (52%), okay (30%), and poor (19%). After reading the information sheets, good or very good understanding of screening recommendations improved (65%; P = .05), and agreement with the importance of screening remained high (80%). However, nearly 20% of patients expressed a more neutral or less favorable attitude toward the risk-benefit ratio of screening (P = .09). Agreement that men should undergo screening, that screening helps detect cancer, and that screening saves lives remained high, regardless of the exposure.
Overall, patients favor PCa screening, but heightened awareness of the current controversy raises concerns about its potential harms. PCa screening is a complex issue, and insight into changing public opinion will be crucial to our future discussions with patients who are wrestling with the decision whether to undergo screening.
Decision making and prostate cancer screening
2014, Urologic Clinics of North America
Citation Excerpt :
Most of these surveys of the implementation prostate cancer screening guidelines have focused on the USPSTF recommendations. For example, Caire and colleagues27 found that most of those men seen in a screening clinic disagreed with the earlier USPSTF recommendations to discontinue screening at age 75. More recently, a survey of a national online panel found that 62% agreed with USPSTF recommendations against prostate cancer screening with PSA, but only 13% intended to follow the guidelines and forego PSA testing.28
Re: Prostate cancer screening in men 75 years old or older: An assessment of self-reported health status and life expectancy
2011, Journal of Urology
Urologic oncology
2016, Primer of Geriatric Urology, Second Edition
Have screening harms become newsworthy? News coverage of prostate and colorectal cancer screening since the 2008 USPSTF recommendation changes
2014, Journal of Behavioral Medicine
Patterns of care for elderly men diagnosed with favorable-risk prostate cancer from 2004 to 2008 : A population-based analysis
2013, American Journal of Clinical Oncology: Cancer Clinical Trials

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: Supported by research funds from the Committee for Urologic Research, Education, and Development (CURED) of Duke University (A.A.C., L.S., D.A.S., B.D.L., M.M.P., T.J.P., K.E.M., C.N.R., D.M.A., and J.W.M.).

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OncologyPublic Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75

Objectives

Methods

Results

Conclusions

Section snippets

Public Survey

Results

Comment

Conclusions

J Urol

J Urol

Urology

J Urol

Surgery

Eur Urol

Actas Urol Esp

Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement

Ann Intern Med

Prostate cancer early detectionClinical practice guidelines in oncology

J Natl Compr Cancer Netw

Mortality results from a randomized prostate-cancer screening trial

N Engl J Med

Oncology
Public Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75