Use of the prostate-specific antigen (PSA) test in the United States for men age ≥65, 1999-2015: Implications for practice interventions

Background Various professional organizations have issued recommendations on use of the PSA test to screen for prostate cancer in different age groups. Aims Using Medicare claims databases, we aimed to determine rates of PSA testing in the context of screening recommendations during 1999-2015 for US men age >= 65, stratified by age group and census regions, after excluding claims relating to all prostate-related conditions. Methods and Results Medicare claims databases encompassed 9.71-11.12 million men for the years under study. PSA testing rate was the proportion of men with >= 1 test(s) per 12 months of continuous enrollment. Men diagnosed with any prostate-related condition were excluded. Annual percent change (APC) in PSA test use was estimated using joinpoint regression analysis. In 1999-2015, annual testing rate was 10.1%-23.1%, age >= 85; 16.6%-31.0%, age 80-84; 23.8%-35.8%, age 75-79; 28.3%-36.9%, age 70-74; and 26.4%-33.6%, age 65-69. From 1999 to 2015, PSA testing rate decreased 40.7%, 29.9%, 13.9%, and 2.9%, respectively, for men age >= 85, 80-84, 75-79, and 70-74. For men age 65-69, test use increased by 0.3%. Significant APC trends were: APC(1999-2002) = +8.1%, P = .029 and APC(2008-2015) = -9.0%, P < .001 for men age >= 85; APC(2008-2015) = -7.1%, P = .001 for men age 80-84; APC(2001-2015) = -2.5%, P < .001 for men age 75-79; APC(2008-2015) = -3.3%, P = .007 for men age 70-74; and APC(2010-2015) = -5.2%, P = .014 for men age 65-69. Coclusion Although decreased from 1999 to 2015, PSA testing rates remained high for men age >= 70. Further research could help understand why PSA testing continues inconsistent with recommendations.