Since the US Preventive Services Task Force (USPSTF) recommendations against routine prostate cancer screening in 2012, prostate cancer grade at diagnosis has migrated toward higher Gleason grade groups (GG), investigators reported at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana.
Leonardo D. Borregales, MD, of The University of Texas Health Science Center in Houston, and colleagues examined 2010-2018 data from the Surveillance, Epidemiology, and End Results (SEER) database involving 438,432 men. GG1 cancers as a proportion of all prostate cancers declined from 47% in 2010 to 32% in 2018, he reported. GG1 at radical prostatectomy pathology also significantly declined from 31.5% in 2010 to 9.9% in 2018. Over the same period, the age-adjusted rate of GG1 disease dropped from 52 to 26 cases per 100,000.
Concurrently, GG 2-5 prostate cancers increased, especially after 2014, according to Dr Borregales. GG3 increased as a proportion of prostate cancers from 10.7% in 2014 to 13.5% in 2018. GG4 increased from 9.6% in 2014 to 10.8% in 2018. GG5 increased from 9.3% in 2010 to 11.0% in 2018.
Distant metastases as a proportion of prostate cancer diagnoses increased from 3.0% in 2010 to 5.2% in 2018, Dr Borregales confirmed. A 2022 study published in JAMA Network Open and a 2019 Cancer study, both using SEER data, also documented a recent increase in metastatic prostate cancers at diagnosis.
In this cohort, the median PSA at diagnosis significantly increased from 6.2 to 7.1 ng/mL. Use of magnetic resonance imaging (MRI) and biomarkers increased from 7.2% in 2012 to 17% in 2019 and 1.3% in 2012 to 13% in 2019, respectively.
“Changes in screening practices are the best primary explanation for the grade shift observed, as there was relatively low uptake of pre-biopsy MRI during our study period and there was insufficient data to support a significant effect of biomarkers or increased incidence of risk factors of high-grade [prostate cancer] such as obesity,” Dr Borregales and colleagues noted in a study abstract. “Further research is needed to examine the downstream effects of these changes in [prostate cancer]-specific mortality.”
In an interview, co-investigator Jim C. Hu, MD, MPH, of NewYork-Presbyterian’s Lefrak Center for Robotic Surgery, agreed that the USPSTF 2012 recommendations are “obsolete.” He said the challenge with the current grade C USPSTF recommendation of individualized choice for PSA testing at ages 55 to 69 years is that it is based on age criteria from the European Randomized Study of Screening for Prostate Cancer (ERSPC). “Currently, we don’t have level 1 guidance for PSA screening in younger men, Black men, and those with a significant family history of prostate cancer,” he said.
As for advice to urologists, Dr Hu said, “Men should have a baseline PSA test in their 40s to determine the future frequency of PSA testing based on [individual] risk stratification.”
Borregales L, DeMeo G, Cheng E, et al. Grade migration of prostate cancer at diagnosis following the US Preventive Services Task Force recommendations on prostate cancer screening. Presented at: AUA 2022; May 13-16, 2022, New Orleans, Louisiana. Abstract PD03-06.
Borregales L, DeMeo G, Gu X, et al. Grade migration of prostate cancer in the United States during the last decade. J Natl Cancer Inst. 2022 Mar 28:djac066. doi:10.1093/jnci/djac066