In a study reported in JAMA Network Open, Burgess et al found that the 2012 U.S. Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening for all men appeared to be associated with ending of a trend of annual reductions in prostate cancer–specific mortality. Updated 2018 USPSTF guidelines support shared decision-making on PSA screening.
Study Details
This cross-sectional study used Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research maintained by the National Center for Health Statistics to obtain data on all men who died of prostate cancer from 1999 to 2019. Trends in prostate cancer–specific mortality rates for the period 1999 to 2012 and the period 2014 to 2019 were compared, with 2013 serving as a washout year.
This cross-sectional study using comprehensive prostate cancer–specific mortality data through 2019 demonstrated decreasing prostate cancer–specific mortality rates that flattened or increased after the 2012 USPSTF Grade D recommendation, suggesting that decreased PSA screening may be a factor associated with this change. This change was seen across ages, races and ethnicities, urbanization categories, and U.S. Census regions. The updated 2018 USPSTF guideline supporting shared decision-making may reverse these trends in the coming years.— Burgess et al
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Key Findings
A total of 618,095 patients who died of prostate cancer from 1999 to 2019 were included in the analysis. Age-adjusted prostate cancer–specific mortality decreased linearly at a rate of −0.273 per 100,000 population per year from 1999 to 2012, followed by a rate of −0.009 per 100,000 population per year from 2014 to 2019 (P < .001).
Changes in age-adjusted rates per 100,000 population per year were most marked for:
- Men aged 60 to 64 years (from –0.0088 to +0.0014)
- Men aged 65 to 69 years (from –0.024 to + 0.0011)
- Men aged ≥ 80 years, who exhibited the largest absolute difference in rates (+0.06 for those aged 80–84 years, +0.07 for those aged ≥ 85 years or older)
- Black men (from –0.700 to –0.091).
Changes were observed across races/ethnicities, urbanization categories, and U.S. Census regions.
These observations were accompanied by the finding of increased diagnosis of metastatic disease. The rates of age-adjusted incidence of localized prostate cancer decreased between 1999 and 2012, and were generally flat from 2014 on, although increases were observed in some age groups. In contrast, the rate of diagnosis of metastatic disease per 100,000 population per year increased from a range of –0.004 to +0.001 between 1999 and 2012 to a range of +0.02 to +0.03 between 2014 and 2017. The increase in diagnosis of metastatic disease was most marked in men aged ≥ 60 years; for example, the rate increased from 0.00047 during 1999 to 2012 to +0.017 for 2014 to 2017 (P < .001) among men aged 60 to 64 years.
The investigators concluded, “This cross-sectional study using comprehensive prostate cancer–specific mortality data through 2019 demonstrated decreasing prostate cancer–specific mortality rates that flattened or increased after the 2012 USPSTF Grade D recommendation, suggesting that decreased PSA screening may be a factor associated with this change. This change was seen across ages, races and ethnicities, urbanization categories, and U.S. Census regions. The updated 2018 USPSTF guideline supporting shared decision-making may reverse these trends in the coming years.”
Sophia C. Kamran, MD, of the Department of Radiation Oncology, Massachusetts General Hospital, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
