The impact of United States Preventive Services Task Force (USPTSTF) recommendations against PSA testing on PSA testing in Australia.

Abstract

Introduction/ Background: To assess the impact of 2012 (May) United States Preventive Services Task Force (USPTSTF) recommendation on PSA testing, prostate biopsy and prostatectomy in Australia using Medicare data. Method: Using Medicare item numbers for PSA (66659),Prostate biopsy (37219), Prostatectomy (37210) and Prostatectomy with lymph node dissection (37211) the occurrence 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 results were stratified for the three groups of 45-54, 55-64 and 65-74 years old. Results: Steady decline in per capita incidences of all fur numbers assessed were observed for the three consecutive financial years since the publication of USPTSTF recommendation statement. These declines were observed across all states. The nationwide incidences of PSA testing for 2012, 2013, 2014 and 2015 financial years were 485, 478, 457 and 406 per 100 000 capita respectively. Similarly the nationwide incidences of prostate biopsy for 2012, 2013, 2014 and 2015 financial years were 120, 110, 96 and 77 per 100 000 capita respectively. These declines were observed fro all the three age groups assessed. Conclusions: Since the introduction of USPTSTF recommendation statement there has been a steady 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 on signifcant 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.