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USPSTF Recommendation May Increase Risk for Prostate Cancer

Surabhi Dangi-Garimella, PhD
A study published in The Journal of Urology suggests the Grade D recommendation for PSA-based screening may place those with intermediate and high-risk prostate cancer at risk.
The US Preventive Services Task Force (USPSTF) released a Grade D recommendation against regular prostate-specific antigen (PSA)–based screening for prostate cancer in 2011. Now, a study published in The Journal of Urology suspects the reduction in intermediate and high-risk cancer diagnoses may delay disease diagnoses in men who may benefit from treatment.

Based on supporting clinical evidence on outcomes of PSA-based screening and subsequent treatment, the USPSTF statement said that the reduction in prostate cancer mortality after 10 to 14 years following screening is very small, with no apparent reduction in all-cause mortality. In contrast, “Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit,” the task force wrote. Consequently, men who remain asymptomatic may be subjected to unnecessary debilitating treatment.

The second most common cancer in the United States following skin cancer, prostate cancer is annually diagnosed in approximately 221,000 men and the disease is responsible for over 27,000 deaths per year. More common in older men (60% of cases in men 65 years or older), it is the second leading cause of cancer death in men in the United States after lung cancer. However, most men diagnosed with lung cancer do not die from the disease.

In the current study, the authors identified incident cancers diagnosed between January 2010 and December 2012 in the National Cancer Database and conducted an interrupted time series to evaluate the trend of new prostate cancers diagnosed before and after the guideline. Colon cancer incidence was used as a comparator. The study found that while incident monthly prostate cancer diagnoses significantly decreased at a rate of over 12% in the immediate month following the issuance of the guideline, and at an average rate of 1.8% per month thereafter from this baseline rate. While the diagnoses of low, intermediate, and high risk prostate cancers reduced, nonlocalized disease diagnoses remained unchanged.

“Our study was designed to assess the impact of the USPSTF recommendation on screening practices among urologists and primary care providers and the incidence of prostate cancer,” said lead investigator Daniel A. Barocas, MD, MPH.

Overall, the 28% decrease in incident diagnoses of prostate cancer in the year after the guidelines were released may have reduced the harms of overdiagnosis and overtreatment of low-risk disease, but there could also have been missed opportunities to diagnose important cancers in men who may benefit from treatment, the authors conclude. “Future research should focus on prostate cancer screening paradigms that both minimize harms and maximize the potential benefits of screening, as well as accounting for individual patient risk factors and preferences,” said Barocas.

 
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