The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System Afshin Aslani, Brian J. Minnillo, Ben Johnson, Edward E. Cherullo, Lee E. Ponsky and Robert Abouassaly* From the Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Cleveland, Ohio Purpose: The United States Preventive Services Task Force recently recom- mended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommen- dation on prostate cancer screening in a large health system. Materials and Methods: We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affil- iated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology). Results: A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar pat- terns were noted in almost all subgroups. The greatest decrease in screening was observed by urologists and in patients in the intermediate age group (50 to 59 years). Conclusions: United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy. Key Words: prostate, prostatic neoplasms, prostate-specific antigen, mass screening, practice guidelines as topic PROSTATE cancer is one of the leading causes of cancer related death in men and has a substantial burden on the health care system. 1,2 In 1994 the Food and Drug Administration approved PSA testing for screening in prostate cancer in men 50 years old or older together with digital rectal examination. 3 This led to a dramatic increase in the incidence of prostate cancer in the United States. 4,5 Stage migration was subsequently noted with a greater proportion of patients diagnosed with low risk, low volume Abbreviations and Acronyms ACP ¼ American College of Physicians AUA ¼ American Urological Association PCP ¼ primary care physician PSA ¼ prostate specific antigen USPSTF ¼ United States Preventive Services Task Force Accepted for publication December 6, 2013. Study received institutional review board approval. Supported by National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases Award T32DK091213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. * Correspondence: Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, 11100 Euclid Ave., Mailstop LKD 5046, Office 4576, Cleveland, Ohio 44106 (telephone: 216-844-4831; e-mail: robert.abouassaly@ uhhospitals.org ). See Editorial on page 1648. 0022-5347/14/1916-1737/0 THE JOURNAL OF UROLOGY ® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. http://dx.doi.org/10.1016/j.juro.2013.12.010 Vol. 191, 1737-1742, June 2014 Printed in U.S.A. www.jurology.com j 1737