Rates of PSA Screening and Early Stage Prostate Cancer Are Declining

Rates of PSA Screening and Early Stage Prostate Cancer Are Declining
Rates of PSA Screening and Early Stage Prostate Cancer Are Declining

The impact on prostate-specific antigen (PSA) screening and prostate cancer incidence before and after the release of the 2012 US Preventive Services Task Force (USPSTF) screening recommendations were examined in two studies published in JAMA (doi:10.1001/jama.2015.14905; doi:10.1001/jama.2015.7273).

Ahmedin Jemal, DVM, PhD, of the American Cancer Society, Atlanta, Georgia, and colleagues examined trends in stage-specific prostate cancer incidence and PSA-based screening for men 50 years and older subsequent to the 2008 and 2012 USPSTF recommendations using the most recent population-based incidence and nationally representative screening data.

Prostate cancer incidence in men 75 years and older substantially decreased following the 2008 USPSTF recommendation against PSA-based screening for this age group. It has been unknown whether incidence has changed since the USPSTF recommendation against screening for all men in May 2012.

The researchers determined prostate cancer incidence (newly diagnosed cases/100,000 men 50 years and older) by stage from 2005 through 2012 using data from 18 population-based Surveillance, Epidemiology, and End Results (SEER) registries. The PSA screening rate was determined for men 50 years and older without a history of prostate cancer who responded to the 2005 (n=4580), 2008 (n=3476), 2010 (n=4157), and 2013 (n=6172) National Health Interview Survey.

The researchers found that the rates of prostate cancer incidence began decreasing in 2008. The largest decrease occurred between 2011 and 2012, from 498 to 416. The number of men 50 years and older with prostate cancer diagnosis nationwide declined by 33 519, from 213 562 in 2011 to 180 043 in 2012. The decreases in incidence were evident in both non-Hispanic white and non-Hispanic black men and across regions.

The percentage of men 50 years and older reporting PSA screening in the past 12 months was 37% in 2005, 41% in 2008, 38% in 2010, and 31% in 2013. In relative terms, screening rates increased by 10% between 2005 and 2008 and then decreased by 18% between 2010 and 2013. Similar screening patterns were found in age subgroups 50 to 74 years and 75 years and older.

In another study, Jesse D. Sammon, DO, of Brigham and Women's Hospital, Boston, and colleagues examined PSA screening data from the 2000, 2005, 2010, and 2013 National Health Interview Survey to determine the prevalence and determinants of screening before and after the 2012 USPSTF recommendations (draft released October 2011), as well as the association between the new USPSTF recommendations and the prevalence of screening.

The final study population included 20 757 men. The prevalence of PSA screening was 34% in 2000 and 2005. Between 2010 and 2013, the prevalence decreased from 36% to 31% overall. In a pooled analysis, survey year 2013 (vs 2010) was associated with lower odds of PSA screening. However, declines were seen only in men younger than 75 years vs men 75 years and older.

The largest declines were seen among men age 50 to 54 years (from 23% to 18%) and among men 60 to 64 years (from 45% to 35%). After adjusting for patient factors, there were significant reductions in PSA screening associated with the 2012 USPSTF recommendations.

"The 2008 USPSTF recommendations against PSA screening in men age 75 years or older have not been associated with changes in screening practices. However, we found a decrease in the prevalence of PSA screening following the 2012 recommendations, particularly in men younger than 75 years," the authors wrote.

“There is reason to be concerned about the decline in prostate cancer screening and prostate cancer incidence reported …” wrote David F. Penson, MD, MPH, of Vanderbilt University, Nashville, Tennessee in an accompanying editorial (JAMA. doi:10.1001/jama.2015.13775).

"Certainly, physicians have been overly aggressive in their approach to prostate cancer screening and treatment during the past 2 decades, but the pendulum may be swinging back the other way. It is time to accept that prostate cancer screening is not an 'all-or-none' proposition and to accelerate development of personalized screening strategies that are tailored to a man's individual risk and preferences. By doing this, it should be possible to reach some consensus around this vexing problem and ultimately help men by stopping the swinging pendulum somewhere in the middle."

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