Is prostate cancer stage migration continuing for black men in the PSA era?

Dobbs, Ryan W.; Greenwald, David; Wadhwa, Harpreet; Freeman, Vincent L.; Abern, Michael R.

doi:10.1038/pcan.2016.68

Cited by 7 publications

(3 citation statements)

References 54 publications

(52 reference statements)

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“…74 75 The NNI and NND were estimated to decrease to 98 and 5, respectively, with lifetime horizon as modelled by Heijnsdijk et al 81 Further, the trend of migration in cancer detection to early stage and favourable grade continues when PSA screening is offered continuously and a 'reverse migration' starts when PSA screening is stopped. [82][83][84][85][86] The PSA retesting interval is recommended to be guided by the baseline PSA value. Studies recommend a PSA retesting interval of 3-8 years at baseline PSA ≤1.00 ng/mL, 4 years at baseline PSA 1-2 ng/mL and yearly at initial PSA >2 ng/mL.…”

Section: Programme Characteristics What Is the Evidence-based Expected Range And Magnitude Of Benefits And Harms For Participants And Socmentioning

confidence: 99%

A discussion on controversies and ethical dilemmas in prostate cancer screening

Mishra

2020

J Med Ethics

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Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions.

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Section: Programme Characteristics What Is the Evidence-based Expected Range And Magnitude Of Benefits And Harms For Participants And Socmentioning

confidence: 99%

A discussion on controversies and ethical dilemmas in prostate cancer screening

Mishra

2020

J Med Ethics

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“…However, these studies encompassed shorter follow‐up after the USPSTF guideline changes. Evaluated trends in the incidence of metastatic prostate cancer by age and race/ethnicity showed conflicting results 8,9,11–13 …”

Section: Introductionmentioning

confidence: 99%

Rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity, 2000–2017

Cao

Zhang

et al. 2021

The Prostate

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Background The 2008 and 2012 United States Preventive Services Task Force (USPSTF) recommendations against prostate‐specific antigen (PSA) screening have led to changes in the incidence pattern of prostate cancer. We sought to examine rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity using the most recent data obtained from Surveillance, Epidemiology, and End Results (SEER) program. Methods SEER*Stat version 8.3.6 was used to analyze annual prostate cancer incidence rates between 2000 and 2017 according to the SEER summary stage, age group, and race/ethnicity group. Incidence rates per 100,000 men were calculated and age‐adjusted to 2000 US standard population. Annual percentage change (APC) was performed to identify the trend in prostate cancer incidence. Results Between 2008 and 2012, trends in incidence of overall and localized prostate cancer significantly declined in comparison with between 2000 and 2007 (APC, −5.4 and −6.0, respectively). However, there was an increase in the incidence rate of both overall and localized prostate cancer from 2014 to 2017 (43.3–46 and 34–34.9 per 100,000 men, respectively). The incidence of regional prostate cancer significantly increased between 2013 and 2017 (5.9–6.8 per 100,000 men; APC, 4.3). Distant disease incidence increased continually between 2008 and 2012 (2.9–3.3 per 100,000 men; APC, 2.3) and between 2013 and 2017 (3.4–4.3 per 100,000 men; APC, 6.0). In addition, these increases in incidence occurred in men of all stratified age and race/ethnicity groups, except for men aged <50 years and American Indian/Alaska Native men. Conclusion This study demonstrates that the longer‐term effects of USPSTF recommendations against PSA screening may have resulted in a reversal of downtrend in prostate cancer incidence, as incidence rates of overall and localized prostate cancer gradually increased from 2014 to 2017. Meanwhile, the trend in stage migration toward advanced disease increased incrementally.

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“…The Will Rogers phenomenon / stage migration has been shown not only in breast cancer but also in lung, prostate and other cancers [13,[21][22][23][24]. Stage migration difference between Whites and Blacks has been well demonstrated in prostate cancer but not demonstrated in other cancers.…”

Section: Introductionmentioning

confidence: 99%

The Will Rogers phenomenon, breast cancer and race

et al. 2021

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Background The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP. Methods This is a retrospective analysis of 300 BC women (2007–2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes. Results Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004). Conclusion The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

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Is prostate cancer stage migration continuing for black men in the PSA era?

Abstract: PC downward stage migration continues in black men but not in white men. Discontinuation of PSA-based screening for PC could disproportionately affect black men.

Cited by 7 publications

References 54 publications

A discussion on controversies and ethical dilemmas in prostate cancer screening

A discussion on controversies and ethical dilemmas in prostate cancer screening

Rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity, 2000–2017

The Will Rogers phenomenon, breast cancer and race

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