The effect of guidelines “has been minimal at best,” says lead author Jesse Sammon, DO, from the Henry Ford Vattikuti Urology Institute in Detroit.

The survey results were reported in a research letter published online September 1 in JAMA Internal Medicine.

Dr. Sammon told Medscape Medical News that his team instigated the study because they could not find any data on the prevalence of screening across the United States. “When we couldn’t find these data, we were totally dumbfounded,” he said. “Here we are making healthcare policy decisions about screening, and we know very little about the current status of screening in the country.”

The team analyzed data from the 2012 Behavioral Risk Factor Surveillance System, which is a joint initiative of the Centers for Disease Control and Prevention and the US states. They focused on data collected between January 2012 and February 2013, and identified male respondents aged 50 or more without a history of prostate cancer or prostate problem who reported undergoing prostate-specific antigen (PSA) testing within the preceding year.

The researchers found that overall, 37.1% had been tested. But there was far more testing in older men compared with younger men.

Nearly half of the older men in the survey had undergone PSA testing — 48.5% of men aged 70 to 74 years and 48.4% of men aged 65 to 69.

The results also show that 45.7% of men aged over 75 years had undergone a routine PSA test, even though 4 years earlier, the US Preventative Services Task Force had specifically recommended against routine PSA screening in this age group.

A few years later, the Task Force recommended against routine screening in any age group, in a draft guideline issued in October 2011, just before the survey was carried out, and the recommendation was then finalized in May 2012, while the survey was being conducted.

At that time, however, the American Cancer Society and the American Urological Association were still recommending that men discuss PSA testing with their doctors — and this recommendation was aimed at men 50 to 75 years.

But the survey found that only 25% of men aged 50 to 54 years had been tested, which is “remarkable,” the researchers comment in their letter.

“If the supposition is that screening has benefit, it is the younger men who would benefit more than elderly,” Dr. Sammon said. “If you are looking at screening as a way of saving lives, the wrong populations are being screened in the United States,” he added.

The results from the survey are a snapshot of how much PSA screening was being carried out in 2012 nationwide. Dr. Sammon said that his team intends to repeat the study to see if PSA screening has since declined.

Previous studies, published in 2012 and 2014, have shown that there was a decline in PSA screening in the period between 2008 and 2012, as reported by Medscape Medical News. During that time, the results from 2 large studies with mortality results from PSA screening were presented and then published (in 2009). The results were equivocal: the European study concluded that PSA screening does save lives from prostate cancer, but the American study, which is now largely accepted to be flawed, did not.

Large Geographic Variation

Another finding from the survey, which is both “concerning and surprising,” is the wide geographic variability seen in the use of PSA screening across the various states, say the researchers.

After adjustment for factors such as age, access to physician, and sociodemographic factors, the prevalence of PSA testing was highest (59.4%) in Hawaii and lowest (24.5%) in New Hampshire. “It is alarming that the prevalence of PSA screening can double from one state to the next,” the researchers comment.

They note that this regional variation for PSA screening is much greater than seen with mammography for breast cancer screening or with colorectal cancer screening, for which one study reported a regional variation of only 7.5%.

“Taken together, these results suggest that national guidelines have had limited effect on clinical practice among healthcare providers,” the researchers conclude.

“The results appear to reflect the prejudices of the primary care providers and physicians,” Dr. Sammon commented. “This is not based on science or evidence, but is based on individual decision making.”

“It is clear that guidelines are not being followed,” he said.

JAMA Intern Med. Published online September 1, 2014. Letter