. Author manuscript; available in PMC: 2017 Jul 1.

Published in final edited form as: Nat Rev Urol. 2016 Dec 20;14(1):26–37. doi: 10.1038/nrurol.2016.251

Table 1.

Papers selected for qualitative synthesis after the USPSTF 2012 recommendation against PSA screening

Outcome	Main Finding	References
PSA Testing Patterns	Decrease in PSA screening rates	^{6, 7, 15–33,38}

	No change /specialty-dependent PSA screening rates (PCPs vs. urologists)	^{17, 28, 37, 39, 41}

	PSA screening rates changed (decreased) in men aged:
	40–49	³²
	50+	^{15, 16, 19, 22, 23, 74}
	50–54	²⁴
	50–59 (decrease)	^6, 17
	50–59 (increase)	²¹
	50–70	^{26, 31}
	55–64	⁷⁴
	55–69	¹⁸
	60+	²¹
	60–64	²⁴
	60–74	⁶
	65–74	⁷⁴
	70+	^{18, 21, 32}
	75+	^6, 32,37

	Inconsistent changes in PSA screening practices among high-risk men	^{18, 27, 38}

Other Tests and Clinical Work-up	Fewer DREs	^{25, 26, 40}
	Fewer clinical work-ups for elevated PSA	^{22, 42, 43}
	Urology referrals at higher PSA values	^{39, 43, 44}
	Increased utilization of risk-stratified screening approaches	^{32, 45}

Biopsy Patterns	Fewer biopsies performed	^{30, 42, 43, 46–50}

	No change in biopsy rates	^{22, 45, 51}

	More positive biopsies	^{43, 63, 64}

	Fewer low-risk/grade cancers detected	^{46, 47, 57, 62}

	Fewer intermediate/high-risk/grade cancers	^{47, 57, 62, 49}

	More intermediate/high-risk/grade cancers	^{43, 44, 46, 50, 64, 65, 66}

Decrease in PC incidence	Decrease in PC incidence	^{19, 22, 47, 57, 59, 60}

	Decrease in loco-regional PC	^{19, 60, 62}

	Increase in clinical stage T3a+	⁴⁴
	No change in distant-stage PC	^{44, 60}
	Increase in distant-stage PC in men 75+	^{44, 19}

	Increase in metastatic disease at diagnosis	^{43, 61}

Effects on longer-term outcomes	Fewer radical prostatectomies performed	⁷²
	Higher Gleason grade and extraprostatic extensions at radical prostatectomy	⁷²
	Fewer patients with low/intermediate risk presenting for radiation oncology	⁷³
	Model-projected outcomes in the U.S. during years 2013–2025 without PSA: - 710,000 to 1.12 million fewer men overdiagnosed; - more than 2-fold increase in metastatic disease; - 36,000–57,000 additional PC deaths	^{75, 76}

Physician Attitudes	Aware of the recommendation, most still willing to consider screening appropriate candidates	^{63, 70, 71}

Patient Attitudes	Most agreed with USPSTF, but still intended to continue screening	^{67, 68}

	Majority pro-screening; anti-screening opinions increased	⁶⁹