Trends in prostate-specific antigen testing from 1995 through 2004

Background: The utility of the prostate-specific antigen (PSA) test to screen for prostate cancer has been widely debated for several years. Whether PSA testing rates have changed during this period of controversy is not well known. Methods: We examined the National Ambulatory Medical Care Survey (1995-2004) of visits to primary care providers by healthy men aged 35 years or older. We examined visits by calendar year and compared the years 2000 through 2004 with the years 1995 through 1999. We also examined visits by men in the overall population and in particular subgroups. Results: Primary care physicians ordered PSA tests in 4.7% of all visits in 1995 and in 7.0% of all visits in 2004 (P=.03). In multivariate analysis, the odds of a primary care physician ordering a PSA test during any clinic visit increased 8% (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12; P < .001) per year from 1995 through 2004. The increase was more pronounced among men making visits for general medical examinations (11.2% in 1995 vs 32.3% in 2004; P = .003). Comparing the period 2000-2004 with the period 1995-1999, the odds of PSA testing increased in nearly all subgroups but most dramatically in black men (OR, 2.3; 95% CI, 1.4-3.8; P = .002) and in men 35 through 49 years of age (OR, 1.8; 95% CI, 1.3-2.6; P = .001). Conclusion: In a nationally representative sample, we found that despite the lack of clear evidence of benefit, PSA testing for prostate cancer screening has increased dramatically, especially among black men and younger men.