Prostate Cancer: More Men At Risk Due To Less Screening

Investigators reporting for The Journal of Urology believe that a controversial recommendation by the U.S. Preventive Services Task Force (USPSTF) could significantly raise the risk of prostate cancer in men going undiagnosed, or being found too late.

With a draft started in 2008 and published in 2011, the USPSTF recommended against regular prostate specific anitgen (PSA) screening, intending in doing so to reduce the risk of over-diagnosis and over treatment in men.

PSA screening was introduced in the 1980s, and total number of deaths due to prostate cancer has been reduced 40 percent since its introduction. Of those reduced deaths, 40 to 70 percent have been attributed to regular PSA screening. 

"Our study was designed to assess the impact of the USPSTF recommendation on screening practices among urologists and primary care providers and the incidence of prostate cancer," lead investigator Daniel A. Barocas, M.D., MPH of the Department of Urologic Surgery at Vanderbilt University Medical Center, said. "We know there is decreased utilization of PSA testing in some institutions and health systems, but has the number of incident cases per month changed substantially since the draft guideline was issued?" 

The study showed that a year after the draft guideline recommendation, diagnoses of new low-risk cancers had dropped 37.9 percent, and that new diagnoses among men over the age of 70 had dropped 23.0-29.3 percent. It also showed a 26.0 percent drop among infirm men, who, along with the elderly, are  at risk to be harmed by treatment before they experience any benefits of early detection. 

These results suggested that the USPSTF recommendation was achieving what it had intended. 

However, in the same time span, the study identified a drop of 28.1 percent in diagnoses of intermediate-risk disease, and 23.1 percent in high-risk prostate cancer, which could result in these men to miss invaluable chances to spare themselves from aggressive cancer, and death. 

"While some of the effects of this guideline may be beneficial in terms of reducing harms of over diagnosis and over treatment, the reduction in intermediate and high-risk cancer diagnoses raises concern for delayed diagnoses of important cancers associated with inferior cancer outcomes," Barocas said. "Future research should focus on prostate cancer screening paradigms that both minimize harms and maximize the potential benefits of screening, as well as accounting for individual patient risk factors and preferences." 

The month after the USPSTF recommendation was issued, the number of prostate cancer diagnoses dropped more than 12 percent, equivalent to 1,363 cases, and by the following year, it had fallen 28 percent overall. Meanwhile, comparatively, many other cancers were diagnosed at stable rates.

Prostate cancer is the second leading cause of death among men in the United States, with the disease claiming 30,000 lives annually.

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