Fewer Men Being Screened, A Rise in Rates of Distant Metastases
The Effect of the 2012 USPSTF Recommendations:
Fewer Men Being Screened, Diagnosed, and Treated for Prostate Cancer
In May, a new study published in the journal Cancer looked at how the previous USPSTF recommendations against PSA screening affected rates of screening and diagnosis rates in the U.S. The study looked at data from more than 6 million privately insured patients in the U.S. The study found that PSA testing, prostate biopsy, and detection of prostate cancer declined significantly between 2009 and 2014, but most significantly after 2011 (when the USPSTF recommendations were reported). The prostate biopsy rate went from 1.95 patients (per 100) to 1.52.
Fewer men also had definitive treatment for prostate cancer, such as surgery or radiation, falling from 69% of diagnosed patients to 54%. In a press release, lead author James T. Kearns, M.D., said the lower rates of treatment likely indicated that more men were choosing active surveillance. He said, “This is important because active surveillance has been shown to be safe in many men, and it avoids problems associated with prostate cancer treatment, such as urinary incontinence and erectile dysfunction. Part of the controversy surrounding prostate cancer screening was that men who didn’t need surgery or radiation for their prostate cancer were still undergoing those treatments. If those men are instead undergoing active surveillance of their low risk prostate cancer, then the harms of screening will be lower.”
A number of other studies similarly found a decline in the number of U.S. men being screened for prostate cancer. Some studies have also found a rise in the number of men diagnosed with nonlocalized prostate cancer. This suggests that less men were being screened in time to catch the disease before it spread. Hopefully, in light of the new USPSTF recommendations, as well as continued improvements in screening and active surveillance methods, this trend will reverse.
Annual Report on Cancer Finds Rise in Late-Stage Prostate Cancer Diagnoses
The Annual Report to the Nation on the Status of Cancer found that overall cancer death rates continue to decline in the U.S. However, the report also noted an increase in new cancer diagnoses of late-stage prostate cancer. Additionally, after decades of decline, prostate cancer mortality has now leveled off.
The report includes data through 2015. From 1999 to 2015, overall cancer death rates decreased by 1.8% per year for men and by 1.4% per year for women.
A companion study examined the trends in prostate cancer rates. From 2007-2014, prostate cancer incidence rates declined an average of 6.5% per year. However, the rates of distant disease (which has already spread from the prostate at the time of diagnosis) increased from a rate of 7.8 new cases per 100,000 in 2010 to 9.2 new cases per 100,000 in 2014. Additionally, after 20 years of declines in prostate cancer mortality between 1993 and 2013, mortality rates have remained stable between 2013 and 2015. This correlates with the time when PSA screening rates declined in the U.S. after the earlier USPSTF recommendations against screening.
The annual report is a joint effort between the National Cancer Institute, part of the National Institutes of Health; the Centers for Disease Control and Prevention; the American Cancer Society; and the North American Association of Central Cancer Registries. The report was published online in the journal Cancer in May.