Association of the USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening With Prostate Cancer–Specific Mortality

Burgess, Laura; Aldrighetti, Christopher M.; Ghosh, Anushka; Niemierko, Andrzej; Chino, Fumiko; Huynh, Melissa; Efstathiou, Jason A.; Kamran, Sophia C.

doi:10.1001/jamanetworkopen.2022.11869

Cited by 23 publications

(18 citation statements)

References 37 publications

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“…But currently, risk models—and polygenic risk in particular—are not incorporated into this shared decision‐making. Burgess et al elegantly show a stagnation in prostate‐specific mortality that followed the shift in the United States’ recommendation against PSA screening 28 . In an effort to find a balance between overdiagnosis and mortality reduction, the United States Preventive Services Task Force has put greater burden on the clinician to triage screening recommendations, 3 a decision that can inadvertently lead to greater health disparities.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a simple prostate cancer risk prediction model based on age, family history, and polygenic risk

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Spaeth²,

Murphy

et al. 2023

The Prostate

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Background: Accurate prostate cancer risk assessment will enable identification of men who are at increased risk of the disease. Using the UK Biobank populationbased cohort, we developed and validated a simple model comprising age, family history, and a polygenic risk score (PRS) to predict 5-year risk of prostate cancer.Methods: Eligible participants were unaffected Caucasian men aged 40-69 years at their baseline assessment who had genotyping data available and had completed 6 or more weeks of follow-up. Family history was the number of affected first-degree relatives: 0, 1, or 2+. We used 264 single-nucleotide polymorphisms (SNPs) of a previously developed 269-SNP PRS and population standardized the PRS to have a mean of 1. Age was categorized into 10-year groups: 40-49, 50-59, and 60-69. In a 70% training data set, we used Cox regression with age as the time axis to model family history, PRS, and age group. The model estimates were used with prostate cancer incidences to derive 5-year risks of prostate cancer. Using 5 years of followup in a 30% testing data set, the model was tested in terms of its association per quintile of risk, discrimination, and calibration.Results: Of the 198 334 eligible participants, 8996 (4.5%) were diagnosed with incident prostate cancer during follow-up and had a mean age of 67.9 (SD = 5.8) years at diagnosis. The best-fitting model included the PRS, family history, 10-year age group, interactions between age and PRS, and age and family history. In the 30% testing data set with follow-up limited to 5 years, the hazard ratio per SD of 5-year risk was 3.058 (95% confidence interval [CI], 2.720-3.438) and the Harrell's C-index was 0.811 (95% CI, 0.800-0.821). Overall, there were 1088 observed and 1159.1 expected prostate cancers, a standardized incidence ratio of 0.939 (95% CI, 0.885-0.996).

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Section: Discussionmentioning

confidence: 99%

“…Burgess et al elegantly show a stagnation in prostate-specific mortality that followed the shift in the United States' recommendation against PSA screening. 28 In an effort to find a balance between overdiagnosis and mortality reduction, the United States Preventive…”

Section: Final Modelmentioning

confidence: 99%

Development and validation of a simple prostate cancer risk prediction model based on age, family history, and polygenic risk

Dite

Spaeth²,

Murphy

et al. 2023

The Prostate

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“… 1 Prostate-specific antigen (PSA) screening, however, has generated a significant debate concerning questionable survival benefits and competing associations with quality of life among men after treatment, such as surgery and radiation therapy. 2 , 3 In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer (grade D). 4 Decreased diagnosis of prostate cancers after the 2012 revised PSA screening guidelines was anticipated and has been reported.…”

Section: Introductionmentioning

confidence: 99%

“…Benefits associated with cancer screening have been extensively documented, in particular, the association of early detection with improved survival in breast and cervical cancers . Prostate-specific antigen (PSA) screening, however, has generated a significant debate concerning questionable survival benefits and competing associations with quality of life among men after treatment, such as surgery and radiation therapy . In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer (grade D) .…”

Section: Introductionmentioning

confidence: 99%

Variations in Age-Adjusted Prostate Cancer Incidence Rates by Race and Ethnicity After Changes in Prostate-Specific Antigen Screening Recommendation

et al. 2022

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ImportanceAfter publication of US Preventive Task Force Prostate-Specific Antigen (PSA) screening guidelines in 2008 and 2012, there have been documented associations with incidence and stage distributions of prostate cancer. It is unclear if these changes were temporary or differed by age or race and ethnicity.ObjectiveTo assess the association of 2008 and 2012 PSA guidelines with prostate cancer incidence by age and race and ethnicity in the US.Design, Setting, and ParticipantsThis cross-sectional study evaluated prostate cancer incidence from 2005 to 2018 in the US using data from the US Cancer Statistics public use database. Data were analyzed from August 2020 through June 2022.Main Outcomes and MeasuresThe primary outcome was the year when rates of prostate cancer incidence changed directionality by age and race and ethnicity. Age-adjusted incidence rates of prostate cancer and corresponding 95% CIs were created, followed by join point regression analysis to evaluate trends of age-adjusted incidence rates of prostate cancer by age, race, Hispanic ethnicity, and stage of diagnosis.ResultsAmong 2 944 387 men with prostate cancer, 2 869 943 (97.5%) men were aged 50 years and older. Men aged 50 years and older accounted for 185 476 of 191 533 Hispanic individuals (96.8%) and 2 684 467 of 2 752 854 non-Hispanic individuals (97.5%). Men aged 50 years and older accounted for 427 016 of 447 847 African American individuals (95.4%), 12 141 of 12 470 American Indian or Alaska Native individuals (97.4%), 61 126 of 62 159 Asian or Pacific Islander individuals (98.3%), and 2 294 171 of 2 344 392 White individuals (97.9%). Men with unknown race (77 519 men) were excluded from the analysis. A decrease in age-adjusted rate of prostate cancer after the 2008 guideline change was observed in all age groups by race and ethnicity. For example, among African American men ages 65 to 74 years, 10 784 of 807 080 men (1.34%) had a prostate cancer diagnosis in 2007 vs 10 714 of 835 548 men in 2008 (1.28%). The mean annual age-adjusted incidence rates of prostate cancer per 100 000 men were 157.7 men (95% CI, 157.4-158.0 men) in 2005 to 2008 and 131.9 men (95% CI, 131.6-132.2 men) in 2009 to 2012. The number of inflections and annual percent changes (APCs) for segments separated by inflections varied by age, race, and Hispanic ethnicity. For men ages 65 to 74 years, the APC was −6.53 (95% CI, −9.28 to −3.69) for 2009 to 2014 among African American men (2 join points), −5.96 (95% CI, −6.84 to −5.07) for 2007 to 2018 among American Indian or Alaska Native men (1 join point), −6.52 (95% CI, −9.22 to −3.74) for 2007 to 2014 among Asian or Pacific Islander men (2 join points), −7.92 (95% CI, −11.36 to −4.35) for 2009 to 2014 among Hispanic men (2 join points), and −7.02 (95% CI, −9.41 to −4.57) for 2007 to 2014 among White men (2 join points).‬‬‬‬‬‬‬‬Conclusions and RelevanceIn this study, men in different age, race, and ethnicity groups had different APC patterns after 2008 and 2012 PSA screening guideline changes. These findings may provide important data on the timing and durations of changes in cancer diagnoses that are associated with changes in PSA screening recommendations and may be valuable for targeted strategies to reduce regional- and distant-staged cancers.

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“…2 Burgess et al suggest that the USPSTF screening guidelines were temporally associated with stagnant or worsening PCa death rates. 3 The death rates for the 13 years before the USPSTF guidelines were issued demonstrated a dramatic 50% overall reduction. The rates afterward were associated with a worrisome trend and little further progress.…”

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confidence: 99%

Point-Counterpoint: Screening vs Diagnostic Testing: Focus on the Patient, Not Dogma

Boxer

Friedman

2023

Urology Practice

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Association of the USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening With Prostate Cancer–Specific Mortality

Cited by 23 publications

References 37 publications

Development and validation of a simple prostate cancer risk prediction model based on age, family history, and polygenic risk

Development and validation of a simple prostate cancer risk prediction model based on age, family history, and polygenic risk

Variations in Age-Adjusted Prostate Cancer Incidence Rates by Race and Ethnicity After Changes in Prostate-Specific Antigen Screening Recommendation

Point-Counterpoint: Screening vs Diagnostic Testing: Focus on the Patient, Not Dogma

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