Use of prostate-specific antigen testing is in the eye of the beholder
Menée aux Etats-Unis à partir des données d'une enquête portant sur 1 222 patients ayant consulté un urologue ou un médecin généraliste entre 2010 et 2012 (âge : 50 à 74 ans), cette étude analyse l'évolution de l'usage du test PSA avant et après la publication des recommandations 2012 de l'US Preventive Services Task Force
In this issue of JAMA Internal Medicine, Zavaski et al report that since the release of the US Preventive Services Task Force statement, the rate of PSA testing has declined overall but still is performed more frequently for patients receiving PSA testing for preventive health reasons through their urologist rather than through their primary care physician. The vast majority of PSA testing is still performed by primary care physicians, but there seems to be a continued perception, more firmly held by urologists than by primary care physicians, that the screening is beneficial. Urologists may hold this belief because they have referred more men who request PSA testing or because they have seen more poor outcomes from metastatic prostate cancer. Regardless, recent data show some decline in the detection of early-stage prostate cancer, which likely reflects decreased ordering of PSA tests, and hopefully indicates avoidance of harms of cancer treatment, such as erectile dysfunction and urinary incontinence.3 We will need to await data on rates of metastatic disease and prostate cancer deaths to understand the full effect of less PSA testing. To our knowledge, such data were not available 30 years ago when the PSA blood test became available. The American Urologic Association Quality Registry was developed in 2014 to better track prostate cancer care and should produce the type of information our patients deserve.
JAMA Internal Medicine , éditorial, 2015