The impact of the United States Preventive Services Task Force (USPTSTF) recommendations against prostate-specific antigen (PSA) testing on PSA testing in Australia

Abstract

OBJECTIVE: To assess the impact of USPTSTF recommendations on PSA testing, prostate biopsy and prostatectomy in Australian men based on the available Medicare data. PATIENTS AND METHODS: Events were identified using Medicare item numbers for PSA (66655,66659), prostate biopsy (37219), prostatectomy (37210) and prostatectomy with lymph node dissection (37211) The occurrences of each procedure was queried per 100 000 capita for consecutive financial years over the period 2000-2015. For each item number reports were also generated for all Australian states. For PSA testing the data was stratified for the three age groups of 45-54, 55-64 and 65-74 years old. For assessment of the rate of prostatectomy the capita rate values for two item numbers of prostatectomy (37210) and prostatectomy with lymph node dissection (37211) were summed up. RESULTS: Steady declines in per capita incidences of all five item numbers assessed were observed for the three consecutive financial years (2013-2015) since the publication of USPTSTF recommendation statement. These declines were observed across all Australian states. When examining the rate of PSA testing for the three age brackets 45-54, 55-64 and 65-74 years old similar trends were identified CONCLUSIONS: Since the introduction of USPTSTF recommendation statement there has been a steady nationwide decline in per capita incidences of PSA testing, prostate biopsy and prostatectomy based on the Australian Medicare data. Whether these declines are in the right direction toward reduction in over diagnosis and over treatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.