GU Symposium 2021: Does Less PSA Screening Mean More Metastatic Prostate Cancer?
Posted: Friday, February 12, 2021
A reduction in prostate cancer screening using prostate-specific antigen (PSA) testing seems to correspond with an increased number of cancers that are metastatic at diagnosis. The U.S. Preventive Services Task Force (USPSTF) did not recommend PSA testing in 2008 or 2012 due to risks related to overdiagnosis and overtreatment of prostate cancer, leading to an overall decrease in such screening. Vidit Sharma, MD, of the University of California Los Angeles, presented these findings on behalf of his colleagues at the virtual edition of the 2021 Genitourinary (GU) Cancers Symposium (Abstract 228).
“The magnitude of decreased PSA screening was correlated to the magnitude of increased metastatic disease, suggesting that there may be a link at [the] population level,” said Dr. Sharma in an American Society of Clinical Oncology press release.
Researchers obtained data from the North American Association of Central Cancer Registries spanning the years 2002 to 2016. The age-adjusted indices for metastatic prostate cancer at diagnosis per 100,000 men were obtained for all 50 states. These data were compared with the survey-weighted PSA screening estimates from each state, obtained from the Behavioral Risk Factor Surveillance System. This system collects information about men aged 40 and older every 2 years since 2002.
Between 2008 and 2016, the number of men screened for prostate cancer decreased from 61.8% to 50.5%, whereas the number of metastatic prostate cancers at diagnosis increased from 6.4 to 9.0 per 100,000. The number of men older than 40 who reported ever undergoing PSA screening varied between 40.1% and 70.3% across the country. Similarly, the age-adjusted incidence of metastatic prostate cancer at diagnosis ranged among states from 3.3 to 14.3 per 100,000. A linear regression model showed that longitudinal reductions in PSA screening among states were associated with increased metastatic prostate cancer diagnoses. States with larger drops in PSA screening had correspondingly larger increases in the incidence of metastatic prostate cancer. This variation in PSA screening prevalence accounted for 27% of the longitudinal variation in metastatic prostate cancer within states.
“We support shared-decision making policies, such as the 2018 USPSTF update, that may optimize PSA screening utilization to reduce the incidence of metastatic prostate cancer in the United States,” concluded the authors.
Disclosure: The authors reported no conflicts of interest.
