Unintended consequences of decreased PSA-based prostate cancer screening

Jang

et al. 2020

Cancer

Self Cite

Background In May 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate‐specific antigen (PSA)–based screening for prostate cancer (PCa), assigning it a grade D. This decision then was modified in 2018 to a grade C for men aged 55 to 69 years. The authors hypothesized that changes in screening practices would reduce survival outcomes for both Black and White men but maintain racial discrepancies in outcomes. Methods Using the Surveillance, Epidemiology, and End Results database, the authors examined PCa‐specific survival based on race and year of diagnosis. The period between January 2010 and December 2012 was categorized as the pre‐USPSTF era, whereas the period between January 2014 and December 2016 was classified as the post‐USPSTF era. The year 2013 was considered the transition year and was excluded from the analysis. Results A total of 49,388 men were identified in the pre‐USPSTF era who were diagnosed with PCa, approximately 83.7% of whom were White and 16.3% of whom were Black. In the post‐USPSTF era, a total of 41,829 men were diagnosed with PCa, approximately 82.7% of whom were White and 17.3% of whom were Black. When compared with the pre‐USPSTF era, men diagnosed in the post‐USPSTF era were found to have more adverse clinical features. In the pre‐USPSTF era, White men were less likely to die of PCa than Black men. This survival disparity between White and Black men was no longer observed in the post‐USPSTF era. Conclusions In men diagnosed with PCa between 2014 and 2016, a survival disparity between White and Black men was not observed due to a decrease in survival among White men while the survival of Black men remained steady.

Section: Discussionmentioning

confidence: 54%

Abrogation of survival disparity between Black and White individuals after the USPSTF′s 2012 prostate‐specific antigen–based prostate cancer screening recommendation

Jang

et al. 2020

Cancer

Self Cite

“…Despite this, screening for PCa with PSA is criticized for its low specificity thereby subjecting men to the harms of overtreatment . Nevertheless, due to the lack of a suitable alternative, controversy still surrounds the effectiveness of relying on PSA alone to screen for PCa . However, in the past decade advancements in imaging modalities, particularly multiparametric magnetic resonance imaging (mpMRI), and improved biopsy techniques are reported to have reduced the number of men undergoing unnecessary procedures and to have also increased detection rates of significant cancer …”

Section: Introductionmentioning

confidence: 99%

“…The decision to do so was based on the results of large randomized control trials, the USA‐based Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the European Randomised Study of Screening for Prostate Cancer (ERSPC) . Following the USPSTF recommendation, there was a significant rise in the detection of high‐grade PCa with a 3.8‐fold increase in the proportion of nodal involvement at the time of surgery . In 2016, the decision not to screen was then reversed and it was agreed that men aged between 55 and 69 with a life expectancy greater than 10 years should engage in shared decision making with their primary physician regarding the benefits and harms of PSA‐based screening in order to make an informed choice .…”

Section: Introductionmentioning

confidence: 99%

“…3,8 Nevertheless, due to the lack of a suitable alternative, controversy still surrounds the effectiveness of relying on PSA alone to screen for PCa. 9 However, in the past decade advancements in imaging modalities, particularly multiparametric magnetic resonance imaging (mpMRI), and improved biopsy techniques are reported to have reduced the number of men undergoing unnecessary procedures and to have also increased detection rates of significant cancer. 10,11 In 2012, uncertainty regarding PSA-based screening heightened when the US Preventative Services Task Force (USPSTF) advised against the screening of asymptomatic men.…”

Section: Introductionmentioning

confidence: 99%

“…12 Following the USPSTF recommendation, there was a significant rise in the detection of high-grade PCa with a 3.8-fold increase in the proportion of nodal involvement at the time of surgery. 9 In 2016, the decision not to screen was then reversed and it was agreed that men aged between 55 and 69 with a life expectancy greater than 10 years should engage in shared decision making with their primary physician regarding the benefits and harms of PSA-based screening in order to make an informed choice. 13 The impact of the USPSTF's change in screening recommendations is yet to be evaluated in Australia.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fifteen‐year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging

England

Li²,

Cohen

2019

ANZ Journal of Surgery

Background The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018. Methods A total of 13 844 Western Australian biopsy‐naive men were assessed to determine trends in age, prostate‐specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre‐biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed. Results Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low‐grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High‐grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high‐grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance. Conclusion In recent years, there has been a significant increase in the diagnosis high‐grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high‐grade tumours but is not a reliable alternative to prostate biopsy.

Trends in Incidence of Metastatic Prostate Cancer in the US

et al. 2022

IMPORTANCEThe US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa). OBJECTIVE To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis