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Decreased Prostate-Specific Antigen Screening and Rate of Diagnosis in Early-Stage Prostate Cancer

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Key Points

  • The frequency of PSA screening has declined significantly in men aged 50 to 74 years and nonsignificantly in those aged ≥ 75 years.
  • The incidence of prostate cancer significantly declined between 2011 and 2012.

Recent data indicated that the rates of prostate-specific antigen (PSA) screening and diagnosis of early-stage prostate cancer have decreased since a 2012 U.S. Preventive Services Task Force (USPSTF) statement (released in October 2011) gave a grade D recommendation against PSA screening for all men. As reported by Sammon et al in a research letter in JAMA, the screening rate has not significantly decreased in men aged ≥ 75 years, despite the 2012 recommendations and a 2008 USPSTF recommendation against PSA screening in this age group. As reported by Jemal et al in JAMA, the incidence of prostate cancer in men aged ≥ 50 years decreased by 16% between 2011 and 2012.

Study of Screening Patterns

In the study by Sammon et al, the prevalence of PSA screening was determined from data from 20,757 men in the 2000 (n = 4,698), 2005 (n = 5,111), 2010 (n = 4,598), and 2013 (n = 6,350) National Health Interview Surveys (NHIS). Men aged ≥ 50 years who reported PSA testing within the 12 months preceding each survey were considered to have undergone screening.

The prevalence of screening was 34% in 2000 and 2005 and decreased from 36% in 2010 to 31% in 2013. The decrease was significant in men aged < 75 years (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.70–0.88) but not among men aged ≥ 75 years (OR = 0.85, 95% CI = 0.66–1.10). The largest declines were seen among men aged 50 to 54 years (from 23% to 18%, OR = 0.71, 95% CI = 0.56–0.91) and 60 to 64 years (from 45% to 35%, OR = 0.69, 95% CI = 0.54–0.89).

Among 10,498 men in the 2010 and 2013 surveys, the likelihood of screening was significantly lower in men in the 2013 survey vs the 2010 survey (OR = 0.79, 95% CI = 0.71–0.88). In addition, the likelihood of screening was significantly higher vs men aged 50 to 54 years for those aged 55 to 59 years (OR = 1.41, 95% CI = 1.18–1.69), 60 to 64 years (OR = 2.40, 95% CI = 1.99–2.90), 65 to 69 years (OR = 3.07, 95% CI = 2.52–3.74), 70 to 74 years (OR = 3.28, 95% CI = 2.60–4.16), and ≥ 75 years (OR = 2.25, 95% CI = 1.86–2.72). In an analysis adjusting for patient factors, the reduction in screening associated with the release of the 2012 USPSTF recommendations was significant (P < .001).

The investigators concluded: “The 2008 USPSTF recommendations against PSA screening in men aged 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.”

Study of Cancer Incidence and Screening Patterns

In the study by Jemal et al, age-standardized prostate cancer incidence by stage from 2005 to 2012 in men aged ≥ 50 years was determined using data from 18 Surveillance, Epidemiology, and End Results (SEER) registries (N = 446,009). The PSA screening rate in the past year among men aged ≥ 50 years was determined from 2005 (n = 4,580), 2008 (n = 3,476), 2010 (n = 4,157), and 2013 (n = 6,172) NHIS data.

Prostate cancer incidence per 100,000 men was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012. The largest decrease was from 498.3/100,000 in 2011 to 416.2/100,000 in 2012, a decrease of 82.1/100,000, which represents a 16% decrease (incidence ratio [IR] = 0.84, 99% CI  = 0.82–0.85). The number of men diagnosed with prostate cancer declined by 33,519 from 2011 to 2012, from 213,562 to 180,043.

The declines in incidence observed since 2008 were confined to local/regional-stage disease and were generally similar across age and race/ethnicity groups. The largest decrease in local/regional-stage disease occurred between 2011 and 2012, from 447.2 to 367.3/100,000, representing a decrease of 18% (IR = 0.82, 99% CI = 0.81–0.84. The incidence of distant-stage disease generally remained stable, except for a significant increase between 2011 and 2012 in men aged ≥ 75 years (from 57.7 to 65.0/100,000); this increase was confined to white men.

The prevalence of PSA screening was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013, representing an increase of 10% (screening rate ratio [SRR] = 1.10; 99% CI = 1.01–1.21) between 2005 and 2008 and a decrease of 18% (SRR = 0.82, 99% CI = 0.75–0.89) between 2010 and 2013. Among men aged ≥ 75 years, the likelihood of screening decreased nonsignificantly between 2008 and 2010 (adjusted rate = 50.1% vs 43.1%, adjusted SRR = 0.86, 99% CI = 0.71–1.04) and between 2010 and 2013 (36.3%, SRR = 0.84, 99% CI = 0.68–1.05). Among men aged 50 to 74 years, the decrease between 2010 and 2013 was significant (36.8% vs 29.9%, adjusted SRR = 0.81, 99% CI = 0.74–0.89).

The investigators concluded: “Both the incidence of early-stage prostate cancer and rates of PSA screening have declined and coincide with 2012 USPSTF recommendation to omit PSA screening from routine primary care for men. Longer follow-up is needed to see whether these decreases are associated with trends in mortality.”

The study reported by Sammon et al was supported in part by a grant from the Vattikuti Urology Institute. The study reported by Jemal et al was supported by the American Cancer Society.

Jesse D. Sammon, DO, of Brigham and Women’s Hospital, is the corresponding author of the JAMA research letter.

Ahmedin Jemal, DVM, PhD, of the American Cancer Society, is the corresponding author of the JAMA article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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