Increase in metastatic prostate cancer in older men has a definitive correlation with changes in prostate cancer screening guidelines recommending against prostate-specific antigen (PSA) testing, according to research published in JAMA Oncology.
PSA tests are designed to measure the level of prostate-specific antigen in a patient’s blood, with elevated levels indicating a likelihood of prostate cancer. The introduction of PSA screening in the early 1990s has helped decrease prostate cancer mortality rates by 50% and incidence of metastases at diagnosis by 70% since then. In 2008, the U.S. Preventative Services Task Force (USPSTF) recommended against PSA testing for men aged 75 years or older, citing evidence of adverse effects including pain, incontinence, and impotence as a result of tests and treatments. By 2012, the USPSTF extended that recommendation to men of all ages, resulting in PSA test exclusion in most annual physicals.
Researchers led by Jim C Hu, MD, MPH, Department of Urology, Weill Cornell Medicine-New York Presbyterian Hospital (NY), investigated the effects of recent declines in PSA screening and prostate cancer incidence on prostate cancer presentation. The Surveillance, Epidemiology, and End Results Program was utilized to examine data involving incidence rates for 1,107,111 men aged 40 years or older who were diagnosed with pathologically confirmed prostate cancer from 2004 to 2013. Subsequent analysis was stratified by age (<75 vs ≥75 years).
Results of the investigation yielded data indicating that the decline in PSA screening has significantly altered the way prostate cancer now presents. Researchers found 12% of men over the age of 75 were diagnosed with metastatic prostate cancer in 2013, compared with 7.8% in 2011. Proportion of men diagnosed with aggressive cancer increased from 68.9% to 72% as well.
Researchers concluded that a definitive correlation exists between changes in prostate cancer screening guidelines and increased metastatic prostate cancer in older men.
“The results underscore the need to reevaluate PSA screening guidelines based on these data and re-evaluation of prior screening trials that led to current PSA testing guidelines from the USPSTF,” said Dr Hu. “The public health message is that after years of decline, the incidence of metastatic disease has gone up.”
Dr Hu also contends that the aforementioned adverse effects from PSA screening are no longer a concern. “The burden of overtreatment and side effects may no longer be sufficient to recommend against routine screening,” he stated.
