Prostate Cancer Treatment Rates Decrease Following Changes in Treatment Recommendations

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Recommendations advising against routine screening for older individuals and PSA screening were released in 2008 and 2011.
Recommendations advising against routine screening for older individuals and PSA screening were released in 2008 and 2011.

Prostate cancer treatment rates decreased 42% after the implementation of recommendations that oppose routine prostate cancer screening. Nonetheless, among patients diagnosed with prostate cancer, treatment rates remain high despite mounting evidence suggesting surveillance might be more suitable.1

The decrease reflects guidelines that changed to limit overdiagnosis and overtreatment. Among patients who are diagnosed, however, only 8% less are undergoing initial surgery or radiation treatment. This slight decrease does not reflect the evidence that shows surveillance can be substituted for treatment in patients with low-risk disease.

"It's not entirely surprising: primary care doctors who perform the majority of screening were the target audience of U.S. Preventive Services Task Force guidelines recommending against screening,” explained first author Tudor Borza, MD, MS, a urologic oncology and health services research fellow at University of Michigan Medicine in Ann Arbor, Michigan. 

“But the specialists who treat prostate cancer once it's diagnosed had a more tempered response."

Researchers used Medicare claims data, identifying 67023 men with newly diagnosed prostate cancer between 2007 and 2012. Almost three-quarters of those patients received initial curative therapy.

In 2008, the U.S. Preventive Services Task Force advised against routine screening in men older than 75 years. A new recommendation advising against all PSA screening was released in 2011, though various societies continue to advocate for screening, especially in men most likely to benefit.

This study revealed a 42% decline in treatment rates from 2007 to 2012, reflecting the changing recommendations.

"These findings suggest that primary care doctors significantly decreased the number of patients to whom they recommended PSA screening after the guidelines changed," Dr Borza said.

"Primary care doctors make recommendations for screening to men who do not have cancer. They see men who have been treated for prostate cancer and have long-term effects such as incontinence or impotence. That favors a less-aggressive approach to the disease."

Though the risks of overtreatment are increasingly well understood, treatment rates only decreased 8% between 2007 and 2012.

"Specialists understand how insidious prostate cancer can be. They recognize the problems arising from overdiagnosis and overtreatment, but they also see people suffering from painful metastases or dying from the disease,” Borza said.

“When you're exposed to that, you're likely going to have a more reserved approach towards surveillance strategies."

This study further examined a subgroup of patients who were at a high risk of death from a cause other than prostate cancer within 10 years. In this group, the risks of treatment outweigh the benefits. Perhaps surprisingly, there was no change in the treatment rates in these men.

“But there was no change in their treatment rate, meaning that adoption of less aggressive treatment strategies is occurring more slowly than the decrease in PSA screening," explained Dr Borza.

Research continues to reveal new information on identifying men at the highest risk of aggressive prostate cancer. This type of research could help guide treatment decisions.

Reference

1. Michigan Medicine. Prostate cancer treatment rates drop, reflecting change in screening recommendations. https://www.eurekalert.org/pub_releases/2017-01/uomh-pct010917.php. Eureka Alert website. Published January 9, 2017. Accessed January 27, 2017.

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