Department of Urology, Weill Cornell Medicine, New York, New York.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York.
JAMA Surg. 2017 Feb 1;152(2):192-198. doi: 10.1001/jamasurg.2016.3987.
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.
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.
The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening.
Change in median biopsy and RP volume per urologist and national procedural volume.
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).
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.
研究表明，自 2012 年美国预防服务工作组（USPSTF）建议反对前列腺特异性抗原筛查以来，前列腺特异性抗原筛查的使用显著下降。
确定 2012 年 USPSTF 建议后前列腺癌诊断和治疗实践模式的后续影响。
设计、设置和参与者：评估了 2009 年至 2016 年认证和重新认证泌尿科医生的程序量，以评估前列腺活检和根治性前列腺切除术（RP）量的变化。使用纽约州规划和研究合作系统和全国住院患者样本确认了趋势。该研究包括了来自各种实践环境的代表性泌尿科医生样本和全国所有 RP 出院的代表性样本。我们从美国泌尿科委员会获得了手术病例记录，并确定了至少进行了 1 次前列腺活检（n=5173）或 RP（n=3748）的泌尿科医生。
2012 年 USPSTF 建议反对常规人群前列腺特异性抗原筛查。
每位泌尿科医生的中位数活检和 RP 量以及全国程序量的变化。
USPSTF 建议后，每位泌尿科医生的中位数活检量从 29 降至 21（四分位距[IQR]，12-34；P<0.001）。在调整医生和实践特征后，2012 年之后活检量下降了 28.7%（参数估计，-0.25；SE，0.03；P<0.001）。同样，USPSTF 建议后，每位泌尿科医生的中位数 RP 量从 7（IQR，3-15）降至 6（IQR，2-12）（P<0.001），在调整后的分析中，RP 量下降了 16.2%（参数估计，-0.15；SE，0.05；P=0.003）。
USPSTF 建议后，前列腺活检和 RP 量显著下降。需要全景视角来评估 2012 年 USPSTF 建议的长期后果。
