Prostate cancer (PCa) diagnoses decreased after the release of the U.S. Preventive Services Task Force (USPSTF) draft recommendation against routine PSA screening, according to investigators.
Seeking to understand and quantify the impact of the October 2011 draft guideline, Daniel A. Barocas, MD, of Vanderbilt University Medical Center in Nashville, and colleagues compared PCa diagnoses in the months before and after the guideline, 2010-2012. The investigators searched the National Cancer Database, a registry that captures 70% of new cancer diagnoses in the U.S. regardless of patient age and payer.
Results showed that PCa diagnoses decreased by 1,363 cases or 12.2% in the month after release of the controversial recommendation and continued to decrease. In the following year, diagnoses decreased by 28% overall, the researchers reported in The Journal of Urology. Colon cancer diagnoses, by contrast, remained stable over the time period, indicating that the USPSTF guideline was the driving force behind the downward trend in PCa diagnoses. The across-the-board decreases did not vary by age, race, income, insurance, or the presence of co-existing illnesses. Identification of low-, intermediate- and high-risk PCa all decreased, whereas diagnoses of non-localized disease stayed the same.
The goals of limiting PSA screening were to reduce harms such as overtreatment of indolent cancers and elderly men, who would likely die of other causes. A year after the release of the draft recommendation, diagnoses of low-risk PCa decreased by 38% and continued to fall. New diagnoses also decreased by 23%–29% among men older than age 70 and by 26% among the very ill.
The study also revealed some disturbing trends, however: “Our study revealed a 28.1% reduction in diagnoses of intermediate-risk disease and a 23.1% reduction in diagnoses of high-risk PCa 1 year after the draft guideline. This suggests that decreased screening could result in missing important opportunities to spare these men from progressive disease and cancer death,” the investigators wrote. Over the brief study period, they also observed a concerning uptick in diagnoses of non-localized disease.
The investigators suggest future research focus on PCa screening models that maximize benefits and minimize harms, while considering individual patient risk factors and preferences.