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Original Investigation
February 2017

National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening

Author Affiliations
  • 1Department of Urology, Weill Cornell Medicine, New York, New York
  • 2Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
  • 3Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
  • 4Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
JAMA Surg. 2017;152(2):192-198. doi:10.1001/jamasurg.2016.3987
Key Points

Question  What are the downstream effects of the 2012 US Preventive Services Task Force recommendation against prostate-specific antigen screening on practice patterns in prostate cancer diagnosis and treatment?

Findings  Among operative case logs from a nationally representative sample of urologists, prostate biopsy and radical prostatectomy volume decreased by 28.7% and 16.2%, respectively, following the 2012 US Preventive Services Task Force recommendation.

Meaning  These findings represent the downstream effects of the US Preventive Services Task Force recommendation.

Abstract

Importance  Studies demonstrate that use of prostate-specific antigen screening decreased significantly following the US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen screening in 2012.

Objective  To determine downstream effects on practice patterns in prostate cancer diagnosis and treatment following the 2012 USPSTF recommendation.

Design, Setting, and Participants  Procedural volumes of certifying and recertifying urologists from 2009 through 2016 were evaluated for variation in prostate biopsy and radical prostatectomy (RP) volume. Trends were confirmed using the New York Statewide Planning and Research Cooperative System and Nationwide Inpatient Sample. The study included a representative sample of urologists across practice settings and nationally representative sample of all RP discharges. We obtained operative case logs from the American Board of Urology and identified urologists performing at least 1 prostate biopsy (n = 5173) or RP (n = 3748), respectively.

Exposures  The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening.

Main Outcomes and Measures  Change in median biopsy and RP volume per urologist and national procedural volume.

Results  Following the USPSTF recommendation, median biopsy volume per urologist decreased from 29 to 21 (interquartile range [IQR}, 12-34; P < .001). After adjusting for physician and practice characteristics, biopsy volume decreased by 28.7% following 2012 (parameter estimate, −0.25; SE, 0.03; P < .001). Similarly, following the USPSTF recommendation, median RP volume per urologist decreased from 7 (IQR, 3-15) to 6 (IQR, 2-12) (P < .001), and in adjusted analyses, RP volume decreased 16.2% (parameter estimate, −0.15; SE, 0.05; P = .003).

Conclusions and Relevance  Following the 2012 USPSTF recommendation, prostate biopsy and RP volumes decreased significantly. A panoramic vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation.

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