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Research Letter |

Differences in Prostate-Specific Antigen Testing Among Urologists and Primary Care Physicians Following the 2012 USPSTF Recommendations

Michael E. Zavaski, MD1,2; Christian P. Meyer, MD1,2; Jesse D. Sammon, DO1,2; Julian Hanske, MD1,2; Soham Gupta1,2; Maxine Sun, MPH1,2; Quoc-Dien Trinh, MD1,2
[+] Author Affiliations
1Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
2Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2016;176(4):546-547. doi:10.1001/jamainternmed.2015.7901.
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This survey study compares the use of prostate-specific antigen testing among men aged 50 to 74 years before and after the 2012 United States Preventive Services Task Force guidelines were issued.

The use of prostate-specific antigen (PSA) testing for early detection of prostate cancer remains controversial.1 In October 2011, the US Preventive Services Task Force (USPSTF) issued a recommendation against PSA screening for all men.2 This change was associated with a decline in rates of PSA testing among men aged 50 to 74 years and a decline in cases of incident prostate cancer.3,4 Given the evidence for heterogeneity in screening practices,5 we sought to compare the use of PSA testing among urologists vs primary care physicians (PCPs) before and after the latest USPSTF guidelines, hypothesizing that the adoption of these recommendations would vary according to physician specialty.

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PSA Testing Among PCPs and Urologists in Men Aged 50 to 74 Years Before and After the 2012 USPSTF Screening Recommendations

Odds ratios (ORs) demonstrate the association between year and odds of undergoing prostate-specific antigen (PSA) testing within each physician group. The interaction term of physician specialty × survey year assessed the heterogeneity of PSA testing practices. Complex samples logistic regression models adjusted for race/ethnicity, rectal examination at time of PSA test, significant physician characteristics, and patient comorbidities. PCP indicates primary care physician. Light blue line represents urologists; dark blue line, PCPs. The dashes provide a visual cue of the change in screening frequency following the new recommendations.

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Urologists have the most knowledge and experience curing prostate cancer
Posted on February 12, 2016
David L. Keller, MD
Independent Internist
Conflict of Interest: None Declared
As a primary-care internist, my job is often to identify the specialist who has the most knowledge and experience in dealing with my patient's problem. When it comes to early detection and definitive cure of prostate cancer, that specialist is a urologist. The 2 controlled studies relied on by the USPSTF to recommend against PSA screening were poorly designed and badly executed, as I have detailed elsewhere. Only PSA screening can account for the 40% drop in prostate cancer deaths seen since its widespread use. Those internists who are adopting the no-PSA-test policy may be under duress by capitated employers, who do not want to have to pay for robotic prostatectomies or conformal radiation to treat prostate cancer. Let these internists answer to their consciences, their state Medical Boards and their patients' plaintiff attorneys if time proves the USPSTF wrong. Meanwhile, I will continue to test PSA on myself and other eligible men. Information cannot harm anyone, only its misuse can.
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