Following the US Preventive Services Task Force (USPSTF) Grade D recommendations against PSA screening in 2012, more aggressive prostate cancers (PCa) and fewer indolent cancers have been diagnosed, according to a new report based on Surveillance, Epidemiology, and End-Results (SEER) data published in Cancer.

During 2010 to 2015, metastatic PCa diagnoses, according to the American Joint Committee on Cancer stage definition, increased significantly from 6.2 to 7.1 per 100,000 persons among men aged 50 to 74 years, and from 16.8 to 22.6 per 100,000 persons among men aged 75 years or older, Brandon A. Mahal, MD, of the Dana-Farber Cancer Institute/Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues reported. Concurrently, localized PCa diagnoses decreased significantly from 195.4 to 131.9 and from 189.0 to 123.4 per 100,000 persons among men aged 50 to 74 years and 75 years and older, respectively.

Localized cancers stratified by National Comprehensive Cancer Network (NCCN) risk groups likewise showed declines. From 2010 to 2015, the annual incidence of low-risk disease dropped significantly from 60.6 to 31.4 and from 26.1 to 11.6 per 100,000 persons among men aged 50 to 74 years and 75 years and older, respectively. The largest drop occurred between 2011 and 2012 in low-risk PCa incidence (-23% and -32% among men aged 50 to 74 and 75 years and older, respectively) when the USPSTF recommendation against routine screening was issued. 

The annual incidence of intermediate- and high-risk disease declined significantly from 104.2 to 79.3 and from 134.5 to 89.0 per 100,000 persons, respectively, from 2010 to 2014, but then increased in 2015 to 84.3 and 94.7 per 100,000 persons, respectively.


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“Overall, our results demonstrate disease ‘reverse migration’ away from indolent disease and toward more aggressive presentation following 2011-2012 USPSTF Grade D recommendations against PSA screening,” Dr Mahal and colleagues discussed.

“Although it is difficult to determine how many men with low-risk prostate cancer were spared a misdiagnosis, it is likely that many men in this category will live full, healthy lives without having learned of the burdensome finding,” Shreyas Joshi, MD, MPH, and Christopher Filson, MD, of Emory University School of Medicine in Atlanta, commented in an accompanying editorial. “However, it appears that the USPSTF’s recommendation may have been too blunt of a hammer; the policy also affected men who were destined to develop more advanced disease.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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References

Butler SS, Muralidhar V, Zhao SG, et al. Prostate cancer incidence across stage, NCCN risk groups, and age before and after USPSTF Grade D recommendations against prostate‐specific antigen screening in 2012 [published December 3, 2019]. Cancer. 2020;126:717-724. doi: 10.1002/cncr.32604