The incidence of advanced prostate cancer rose and the mortality rate plateaued in most regions across the state of California following the decision to cease routinely screening all men for the disease, according to a recent study published by Van Blarigan et al in JAMA Network Open. The findings reinforced the need for screening that can identify potentially fatal tumors without raising false alarms about those that pose no risk to the patient.
Background
Prostate cancer is the most common cancer type and second-leading cause of cancer-related mortality among U.S. men. Although some tumors are aggressive and can lead to death, the majority of them are low-grade and never metastasize.
The most frequently used screening tool for prostate cancer is prostate-specific antigen testing, which does not differentiate between aggressive or nonaggressive tumors, leading many patients to be diagnosed with cancers that pose little long-term risk. Conversely, if screening isn’t performed, opportunities for timely diagnosis and early treatment of more advanced cancers—which have a 5-year survival rate of just 37%—can be missed.
After years of screening all men for prostate cancer, the U.S. Preventative Services Task Force (USPSTF) stopped recommending the strategy in 2012. They hoped to prevent unnecessary and potentially damaging interventions such as surgery among men whose disease was not serious. The prostate cancer–related mortality rate had been declining for many years prior to the decision.
In 2018, the USPSTF began recommending that men between aged 55 and 69 years discuss the possible risks and benefits of screening with their physicians. However, these conversations may not always be happening.
Study Methods and Results
Investigators analyzed data from nearly 388,000 men with prostate cancer in California between 2004 and 2021. They noted that 7.2% (n = 28,000) of the patients had advanced disease. During the study timeframe, there were 58,754 prostate cancer–related deaths.
The investigators then examined data from 10 regions spanning the state to determine whether the rates in certain areas were increasing more quickly or slowly. They found that the incidence of serious disease, which had been stable or dropping until 2010, increased by 6.7% per year from 2011 to 2021 compared with national rates that were increasing by 4.5% per year from 2011 to 2019. The lowest annual increase was identified in the Southern San Joaquin Valley (2.3%), whereas the highest annual increase was identified in the Central Coast (9.1%).
Prostate cancer–related mortality fell by 2.6% per year between 2004 and 2012 but plateaued in 70% (n = 7) of the regions in the state after 2012. Mortality was highest in the Inland Empire, followed by San Diego–Imperial and North Coast; it was lowest in the San Francisco Bay Area.
Conclusions
“This overall rising trend is alarming and has occurred across age groups, regions of California, races, and ethnicities,” emphasized lead study author Erin L. Van Blarigan, ScD, Associate Professor of Epidemiology & Biostatistics and Urology at the University of California, San Francisco (UCSF) and the university’s Helen Diller Family Comprehensive Cancer Center. “Our data point to how urgent this problem is. Figuring out the best way to screen for prostate cancer continues to be a challenge for researchers and [physicians]. Without screening, the number of men diagnosed with advanced prostate cancer—when treatments are less effective—increases fast,” she indicated.
“It’s important to continue monitoring prostate cancer trends both in California and nationally as we learn more about the impact of screening guidelines on different populations,” concluded senior study author Scarlett L. Gomez, PhD, MPH, Professor in the Department of Epidemiology & Biostatistics at UCSF.
Disclosure: The research in this study was funded by the California Department of Public Health; the U.S. Centers for Disease Control and Prevention’s National Program of Cancer Registries; and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. For full disclosures of the study authors, visit jamanetwork.com.
