Debate on PSA Prostate Cancer Screening Redux

March 2015, Vol 6, No 2

Orlando, FL—A new retrospective study of 87,562 men diagnosed with prostate cancer between January 2005 and June 2013 show that the incidence of prostate cancer and men with prostate-specific antigen (PSA) >10 decreased gradually between 2005 and 2011. However, the incidence of high-risk prostate cancer at diagnosis increased annually by 3% between 2011 and 2013, totaling 6%. This increase could lead to an additional 1400 prostate cancer deaths 10 years later.

These findings were presented at the 2015 Genitourinary Cancers Symposium, resuscitating the debate about PSA screening.

What happened between 2011 and 2013 to account for this increase in higher-risk prostate cancer?

In 2011, the US Preventive Services Task Force (USPSTF) issued a new recommendation against routine PSA screening for all men in the general population. The previous, 2005 USPSTF recommendation was against PSA screening only in older men aged ?75 years.

The new study findings suggest, but do not prove, that adoption of the new USPSTF recommendations could lead to more aggressive cancers at diagnosis, and subsequently more prostate cancer–related deaths. More research is needed to validate these findings, say the investigators.

“Our study is the first to measure changes in prostate cancer presentation in the period following the USPSTF PSA screening recommendations,” said lead investigator Timothy E. Schultheiss, PhD, Director and Professor, Radiation Physics, City of Hope, Duarte, CA.

“Given the findings of our analysis in this time frame, men who are at increased risk for prostate cancer, especially those with a family history of prostate cancer, should consider talking with their doctor about PSA screening,” he said.

“We can only speculate about whether the USPSTF recommendations are responsible” for the increase in higher-risk cases being diagnosed, “but we believe that the USPSTF might reconsider their recommendation,” Dr Schultheiss added.

Need to Reconsider Current Guidelines?

The study included men diagnosed with intermediate- or high-risk prostate cancer based on their blood PSA level >10 ng/mL who were included in the National Oncology Data Alliance (NODA), a database that captures cancer cases at more than 150 US hospitals.

NODA is similar to the National Cancer Institute’s Surveillance, Epidemiology, and End Results database, but includes more recent data for the years 2011-2013.

This was not a screening study per se, Dr Schultheiss emphasized. It just included men who presented to the clinic and were diagnosed with prostate cancer based on their PSA level, but the reasons why they presented to the clinic were not available for analysis.

Commenting on the study, American Society of Clinical Oncology Expert and 2015 Genitourinary Cancers Symposium News Planning Committee team member Charles Ryan, MD, of the University of California, San Francisco, said, “It is far too early to say this is cause and effect. This study adds to the ongoing debate about PSA screening and underscores the importance of reconsidering guidelines.”

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