“This study suggests that reduced PSA screening may come at the cost of more men presenting with metastatic prostate cancer. Patients should discuss the risks and benefits associated with PSA screening with their doctor to identify the best approach for them,” said Robert Dreicer, MD, MS, MACP, FASCO, ASCO expert in genitourinary cancers.
ALEXANDRIA, Va.—Reduced levels of screening for prostate cancer using prostate-specific antigen (PSA) testing correspond with recent increases in the diagnosis of metastatic disease, according to a study that will be presented at the 2021 ASCO Genitourinary Cancers Symposium, taking place virtually February 11-13.
Relationship of PSA screening with metastatic prostate cancer diagnoses
Men in the United States age 40 or older
Decreases in the rate of PSA screening correlated with increases in the diagnosis of metastatic prostate cancer.
The findings add weight to recommendations that men discuss PSA screening benefits and harms with their doctor.
In the United States, the average percentage of men age 40 or older screened for prostate cancer using PSA decreased from 61.8% in 2008 to 50.5% in 2016. At the same time, the average number of men diagnosed with metastatic prostate cancer (after adjusting for age) increased from 6.4 to 9 per 100,000 men.
There was significant variation between states in terms of the percentage of men over 40 years of age who reported ever receiving PSA screening (40.1%-70.3%) and in the incidence of metastatic prostate cancer at diagnosis after adjusting for age (range 3.3 to 14.3 per 100,000 men). However, statistical modeling demonstrated that reductions over time in PSA screening were associated with increased metastatic prostate cancer diagnoses, and states with larger reductions in PSA screening tended to have larger increases in metastatic prostate cancer diagnoses.
“The variation between states is one of the precise strengths of our study. The magnitude of decreased PSA screening was correlated to the magnitude of increased metastatic disease, suggesting that there may be a link at population level,” said Vidit Sharma, MD, lead author and health services fellow in urologic oncology at the University of California Los Angeles.
One set of guidelines, published by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer group of national experts in prevention and evidence-based medicine, did not recommend PSA screening regardless of age in its 2008 and 2012 guidelines. However, these were updated in 2018 to recommend that “men aged 55 to 69 years make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms.” The task force recommended against PSA screening in men over 70.
About the Study
Investigators obtained age-adjusted incidences of metastatic prostate cancer at diagnosis (per 100,000 men) from the North American Association of Central Cancer Registries from 2002 to 2016 for each U.S. state. They also obtained PSA screening estimates for each state from the Behavioral Risk Factor Surveillance System. The system collects this information for men at least 40 years of age every 2 years starting in 2002. The authors then correlated the incidence of metastatic prostate cancer to the proportion of men receiving PSA screening per state.
The investigators plan to look for correlation between decreased screening and mortality, as well as investigating the effects of other factors.
Dr. Sharma was supported by the VA Health Services Research & Development Fellowship.
For Your Readers
ATTRIBUTION TO THE GENITOURINARY CANCERS SYMPOSIUM IS REQUESTED IN ALL NEWS COVERAGE
Founded in 1964, the American Society of Clinical Oncology, Inc. (the Society) is committed to the principle that knowledge conquers cancer. Together with the Association for Clinical Oncology, ASCO® represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of high quality and equitable patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. Conquer Cancer, the ASCO Foundation, supports the Society by funding groundbreaking research and education across cancer’s full continuum. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, Instagram, and YouTube.
About the American Society for Radiation Oncology
The American Society for Radiation Oncology (ASTRO) is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists, and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training live activities as well as online through the ASTRO Academy, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology, Biology, Physics, Practical Radiation Oncology, and Advances in Radiation Oncology, developed and maintains an extensive patient website; and created the Radiation Oncology Institute, a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. Learn more about ASTRO.
About the Society of Urologic Oncology
The Society of Urologic Oncology (SUO) was created in 1984 to enable qualified members primarily interested in the care of patients with malignant genitourinary diseases to meet for the purpose of discussion, development, and implementation of ideas to improve care. The Society and its bylaws conform to the guidelines and bylaws of the American Urological Association (AUA).
The purpose of the SUO is to develop educational and research initiatives and to study issues in urologic oncology and provide physician statements that represent a state of the art assessment of these issues to other organizations.
The Society also provides a forum for identifying the urologic oncologist as a physician with specific expertise in the study and treatment of genitourinary malignancies. In recognition of the multidisciplinary efforts involved in the study and treatment of genitourinary malignancies, the Society seeks to incorporate multiple disciplines in achieving these goals. The Society supports the activities of multiple disciplines in the common objectives of seeking an increased understanding and successful treatment of genitourinary malignancies.
The SUO seeks to improve the care of patients with malignant urologic disease and to provide a forum for the discussion of problems relating to malignant urologic disease. Our objectives include: 1) Stimulating research in and the teaching of urologic oncology, 2) Disseminating the principles of urologic oncology to the medical profession at large, 3) Bringing urologists into a Society whose work is entirely, or principally with malignant disease, 4) Being identified as the most qualified organization on matters relating to urologic oncology, and 5) Standardize fellowship training in urologic oncology.
Please visit our website or call (847) 264-5901 for more information on how to become a member.