Changes in Prostate Cancer Presentation Following the 2012 USPSTF Screening Statement: Observational Study in a Multispecialty Group Practice

Abstract

BACKGROUND: In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer in men of all ages. Following this change, screening declined yet the complete impact on clinical presentation is not well defined in the screeneligible population. OBJECTIVE: To determine if the rates of PSA screening, prostate biopsy, incident prostate cancer detection, and stage IV at presentation in screen-eligible men in Kaiser Permanente Northern California changed following the 2 0 1 2 U S P S T F P r o s t a t e C a n c e r S c r e e n i n g recommendations. DESIGN: Retrospective study spanning the years 2010 to 2015, in screen-eligible Kaiser Permanente Northern California members (African American men ages 45-69 and all other men ages 50-69) with no prior history of prostate cancer. Participants All screen-eligible, male members during 2010 (n = 403,931) to 2015 (n = 483,286) without a history of prostate cancer within all Kaiser Permanente Northern California facilities. MAIN MEASURES: Annual rates of PSA testing, prostate biopsy, incident prostate cancer detection, and stage IV cancer at presentation were compared between the preguideline period, 2010 and 2011, and the post-guideline period, 2014 and 2015, in men under the age of 70. KEY RESULTS: Following the 2012 USPSTF guideline change, screening rates declined 23.4% (95% CI 23.0-23.8%), biopsy rates declined 64.3% (95% CI 62.9-65.6%), and incident prostate cancer detection rates declined 53.5% (95% CI 50.1-56.7%) resulting in 1871 fewer incident cancers detected, and metastatic cancer rates increased 36.9% (95% CI 9.5-71.0%) resulting in 75 more stage IV cancers detected. CONCLUSION: Less screening resulted in a large decrease in cancer detection, some of which may be beneficial as many cancers may be indolent, yet this decrease occurred at the expense of an increase in metastatic cancer rates. For every 25 fewer cancers detected, one metastatic cancer was diagnosed. This information may be valuable in the shared decision-making process around prostate cancer screening.

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

“…1 As noted earlier, Black men present at earlier ages and with more advanced disease but are less likely to have access to screening and guideline-concordant care, when compared with other men. 101 The increasing use of precision genomics and medicine has the potential to improve outcomes for all men with prostate cancer; however, genomic efforts and clinical studies have been highly Eurocentric, and there is a risk of widening disparities in the precision medicine era if efforts continue to not include cohorts that are representative of local, national, and global populations. [102][103][104][105][106] Efforts to address racial differences in prostate cancer outcomes have largely been focused on investigating the contribution of social versus biologic factors in high-risk populations.…”

Evolving Natural History of Metastatic Prostate Cancer

“…Of note, a higher rate of de novo metastatic disease was present in the 2016 cohort than in 2009. In 2012, the United States Preventive Services Task Force (USPSTF) gave a grade D (discourage the use of this service) recommendation for prostate-specific antigen (PSA)-based prostate cancer screening for all age groups [ 21 ]. This large retrospective study of nearly 900,000 screen-eligible men from 2010 and 2015 found a 23.4% (95% CI 23.0 - 23.8%) reduction of screening rates between the two groups.…”

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

“…In 2018, the recommendations were changed again and advised that an informed discussion take place between patients and providers about PSA screening. Black patients likely have lower rates of PSA testing because of lack of consistent information and education, along with numerous other barriers (Table 1) [29–34].…”