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  = +8.1%, P = .029 and APC  = -9.0%, P < .001 for men age ≥85; APC  = -7.1%, P = .001 for men age 80-84; APC  = -2.5%, P < .001 for men age 75-79; APC  = -3.3%, P = .007 for men age 70-74; and APC  = -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.