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Despite lack of evidence of benefit, PSA testing for prostate cancer screening has increased dramatically

Evidence for the value of prostate-specific antigen (PSA) testing for prostate cancer screening remains tenuous. Yet primary care doctors were more likely to order PSA tests in 2004 than in 1995, with the most dramatic increase in testing among black men and younger men, according to a new study. Jeffrey A. Linder, M.D., M.P.H., of Harvard Medical School, and colleagues analyzed 1994-2004 data from the National Ambulatory Medical Care Survey on visits to primary care providers by healthy men aged 35 years and older.

Between 1995 and 2004, orders for a PSA test by primary care doctors during visits jumped nearly 50 percent (from 4.7 to 7 percent) and nearly tripled among clinic visits for a general medical examination (from 11.2 to 32.3 percent). The odds of PSA testing increased for nearly all subgroups from 1995-1999 to 2000-2004. However, the odds for testing more than doubled among black men (odds ratio, OR 2.3), who are at higher risk for prostate cancer, and nearly doubled among men 35 to 49 years of age (OR 1.8). Likelihood of PSA testing also increased more among men with private and Medicare insurance.

Some clinical guidelines recommend a baseline PSA test at age 40, while others recommend one for men younger than 50 only if they have defined risk factors for prostate cancer, such as being black or having a first-degree relative with prostate cancer. Yet the evidence for testing younger men remains weak, and whether screening this age group reduces mortality is unknown, note the researchers. They suggest that doctors may be ordering more PSA tests in part due to more patient requests, belief in the value of PSA screening by physicians and patients, and protection against malpractice suits.

The study was supported in part by the Agency for Healthcare Research and Quality (HS14563).

See "Trends in prostate-specific antigen testing from 1995 through 2004," by Wildon R. Farwell, M.D., M.P.H., Dr. Linder, and Ashish K. Jha, M.D., M.P.H., in the December 10, 2007 Archives of Internal Medicine 167(22), pp. 2497-2502.

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