Fall in PSA screening linked to rise in metastatic prostate cancer diagnoses
medwireNews: The decrease in prostate-specific antigen (PSA) screening in recent years may have come at the cost of increased levels of later-stage disease at prostate cancer diagnosis, suggests research presented at the 2021 Genitourinary Cancers Symposium.
“While PSA screening was found to reduce prostate cancer metastasis and mortality in a large European randomized trial, PSA screening has also resulted in over-treatment of prostate cancer with significant quality-of-life implications,” leading to the US Preventive Services Task Force (USPSTF) recommending against it in 2008 and 2012, explained Vidit Sharma and co-researchers from the University of California, Los Angeles in the USA in the abstract for their poster.
However, “[t]he trend of rising metastatic disease at diagnosis is a worrisome consequence that needs attention,” they added.
“Thus, 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.”
The team collated state-wide data on the age-adjusted incidence of metastatic prostate cancer diagnoses in 2002–2016 from the North American Association of Central Cancer Registries, while survey-weighted PSA screening estimates for men aged at least 40 years during the same time period for each state were obtained from the Behavioral Risk Factor Surveillance System.
The average rate of PSA screening dropped significantly from 61.8% in 2008 to 50.5% in 2016, while the converse was true for the age-adjusted incidence of metastatic disease at diagnosis, which rose from a mean of 6.4 to 9.0 cases per 100,000 men.
Sharma and colleagues found a significant variation between states in the proportion of men who ever underwent PSA screening, with rates ranging from 40.1% to 70.3%, and also in the age-adjusted incidence of metastatic prostate cancer diagnoses, from 3.3 to 14.3 cases per 100,000 men.
But a random-effects linear regression model showed a significant correlation between longitudinal reductions in PSA screening across states and concomitant increases in metastatic prostate cancer, “suggesting that there may be a link at population level,” commented Sharma in a press release.
“Our study strengthens the epidemiologic evidence that reductions in PSA screening are likely responsible for some of the recent increase in metastatic prostate cancer in the United States,” the researchers concluded.
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