ANN ARBOR, Michigan -- January 9, 2017 -- University of Michigan Health System -- As some national guidelines now recommend against routine prostate cancer screening, the overall rate of men receiving treatment for the disease declined 42 percent, a new study finds.
The decline reflects efforts to decrease overdiagnosis and overtreatment - preventing some unnecessary treatments that can cause long-term impact on quality of life, while still providing life-saving care to patients who need it.
But among those who are diagnosed, only 8 percent fewer are getting initial surgery or radiation treatments - even as data shows those with low-risk disease can substitute surveillance.
"It's not entirely surprising: Primary care doctors who perform the majority of screening were the target audience of U.S. Preventive Services Task Force guidelines recommending against screening. But the specialists who treat prostate cancer once it's diagnosed had a more tempered response," says study author Tudor Borza, M.D., M.S., a urologic oncology and health services research fellow at Michigan Medicine.
In a study published in Health Affairs, Michigan Medicine researchers used Medicare claims data to identify 67,023 men newly diagnosed with prostate cancer between 2007 and 2012. Nearly three-quarters of those men had initial curative treatment, such as surgery or radiation.
In comparing overall treatment rates from 2007 till 2012, researchers found a sharp decrease of 42 percent, reflecting a change in screening recommendations and adoption of surveillance strategies in select groups of men. In 2008, the U.S. Preventive Services Task Force advised against routine screening in men older than 75. By 2011, a recommendation came out against all PSA screening. However, specialty societies, such as the American Urological Association, continued to advocate for screening in men who were most likely to benefit.
"These findings suggest that primary care doctors significantly decreased the number of patients to whom they recommended PSA screening after the guidelines changed," Borza says. "Primary care doctors make recommendations for screening to men who do not have cancer. They see men who have been treated for prostate cancer and have long-term effects such as incontinence or impotence. That favors a less-aggressive approach to the disease."
While screening recommendations became less-aggressive, so did attitudes toward treatment. But researchers found a more tempered response when they looked at treatment rates over time among those diagnosed with prostate cancer.
