Research Assesses the Effects of the USPSTF Recommendation

Included in AUA Prostate Cancer Update Course*

The advent of PSA testing in the 1990s led to an increase in the number of men diagnosed with prostate cancer. However, concerns about over-screening and overdiagnosis led professional guidelines, such as those of the U.S. Preventive Services Task Force (USPSTF) to recommend against routine PSA screening. This recommendation remains controversial due to concerns that lack of screening could mean men will not get diagnosed with prostate cancer while it is still localized, when there’s the best chance for a cure.

Dr. Catalona’s AUA Prostate Cancer Update course covered a number of new studies examining the rates of prostate cancer diagnoses and screening in the U.S. following the USPSTF recommendations. Summaries below indicate that fewer men are being screened and diagnosed with prostate cancer, and some studies found an increase in cancers that have spread beyond the prostate at the time of diagnosis.

Trends in United States Prostate Cancer Incidence Rates by Age and Stage, 1995-2012 1

Guidelines discouraging routine prostate cancer screening were temporarily associated with declining rates of localized prostate cancer. However, rates of distant-stage prostate cancer are now increasing in younger men.

• Prostate cancer diagnoses declined since 2001, with a sharp decline from 2010-2012.
• Overall, diagnoses of prostate cancer that spread beyond the prostate have declined since 1995, with a greater decline from 1995-1997 than from 2003-2012.
• Diagnoses of prostate cancer that spread beyond the prostate declined for men 70 years and older from 1995-2012, but increased for men ages 50- 69 years from 2004-2012.

Decrease in Prostate Cancer Testing Following the US Preventive Services Task Force (USPSTF) Recommendations 2

The decline in PSA testing for men 75 years and older could reflect the impact of the 2008 USPSTF recommendations. Decreases in PSA testing between 2010 and 2013 could be early effects of the 2012 USPSTF recommendations.

• PSA testing rates were highest in 2008 and decreased significantly in 2013, especially for men 75 years and older.
• Men ages 50-74 and men 75 years and older had significantly lower percentages of PSA testing in 2013 than in 2010.
• PSA testing percentages were highest in 2008 for Caucasian and African American men. Only Caucasian men had a significantly lower percentage of testing in 2013 than in 2010.

Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations 3

Prostate cancer rates for men 50 years and older began decreasing in 2008, with the largest decrease between 2011- 2012.

• PSA screening rates increased by 10% between 2005-2008 and then decreased by 18% between 2010 and 2013.
• The number of men 50 years and older diagnosed with prostate cancer fell from 213,562 men in 2011 to 180,043 in 2012.
• Declines in incidence since 2008 were confined to local/regional-stage disease and were similar across age and race/ethnicity groups.

Effect of the USPSTF Grade D Recommendation against Screening for Prostate Cancer on Incident Prostate Cancer Diagnoses in the United States. 4

Diagnoses of low-, intermediate-, and high-risk prostate cancers have decreased significantly, but new diagnoses of non-localized disease did not change.

• There was a 28% decrease in prostate cancer diagnoses in the year after the 2011 USPSTF draft recommendation against PSA screening
• Monthly prostate cancer diagnoses decreased by 12.2% in the month after the USPSTF draft guideline, and continued to decrease by 164 cases per month.

1. Cancer Epidemiol Biomarkers Prev. 2016 Feb;25(2):259-63. doi: 10.1158/1055-9965.EPI-15-0723. Epub 2015 Dec 8
2. J Am Board Fam Med. 2015 Jul-Aug;28(4):491-3. doi: 10.3122/jabfm.2015.04.150062
3. JAMA. 2015 Nov 17;314(19):2054-61. doi: 10.1001/jama.2015.14905.
4. J Urol. 2015 Dec;194(6):1587-93. doi: 10.1016/j.juro.2015.06.075. Epub 2015 Jun 15.

*Dr. Catalona’s Prostate Cancer Update Course

Dr. Catalona led the Prostate Cancer Update course at the American Urological Association annual meeting. The course highlighted important findings on prostate cancer published during the last year. The topics are wide-ranging. This issue of QUEST covers some of these articles, which we hope will be of interest to our readers.