By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies
Prostate-specific antigen (PSA) screening rates, along with the incidence of early-stage prostate cancer, have declined since the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation to remove PSA screening from routine care for average-risk men. Some experts remain concerned about the long-term mortality implications of skipping screening and are renewing calls for personalized screening strategies rather than avoiding the test altogether.
Two new studies released Nov. 17 in the Journal of the American Medical Association examined recent changes in PSA screening rates before and after the 2008 and 2012 USPSTF recommendations, which recommended against PSA-based screening for men 75 years and older and for all average-risk men, respectively.
Both studies relied on analysis of National Health Interview Survey data to assess PSA screening rates in the past year among men 50 years and older. The American Cancer Society study additionally examined prostate cancer incidence (newly diagnosed cases/100,000 men aged ≥50 years) by stage from 2005 through 2012 using data from 18 population-based Surveillance, Epidemiology, and End Results registries.
The researchers from the American Cancer Society found that screening rates began decreasing in 2008, but that the largest decrease occurred between 2011 and 2012. Accompanying declines in incidence were seen in local/regional-stage disease and were similar across age and race/ethnicity groups. (This would be expected given concerns of overdiagnosis of low-grade cancers with the PSA test.) The percentage of men 50 years and older reporting PSA screening in the past 12 months was 36.9 percent in 2005, 40.6 percent in 2008, 37.8 percent in 2010, and 30.8 percent in 2013. Similar screening patterns were seen in age subgroups 50 to 74 years and 75 years and older.
“Less screening or discontinuing screening may lead to missed opportunities for detecting biologically important lesions at an early stage and preventing deaths from prostate cancer, the ultimate goal of screening, write the authors led by Ahmedin Jemal, D.V.M., Ph.D., from the American Cancer Society (Atlanta, Ga.). “Longer follow-up is needed to see whether these decreases are associated with trends in mortality.”
While advocates for cutting screening tout the benefits associated with fewer adverse effects of overtreatment of indolent cancer, many experts remain concerned that entirely reversing previous adoption of PSA testing could be harmful to men over the long run.
“It is time to accept that prostate cancer screening is not an ‘all-or-none’ proposition and to accelerate development of personalized screening strategies that are tailored to a man’s individual risk and preferences,” writes David F. Penson, M.D., from Vanderbilt University (Nashville, Tenn.) in an accompanying editorial. “By doing this, it should be possible to reach some consensus around this vexing problem and ultimately help men by stopping the swinging pendulum somewhere in the middle.”