In the Wake of the Previous USPSTF Guidelines

Categories: Spring 2017
Recent research found declines in the numbers of U.S. men who were getting screened, diagnosed and therefore treated for prostate cancer in the wake of the 2008 and 2011 USPSTF recommendations against PSA testing. Fewer men were being screened for prostate cancer and less cancer was being caught while it was still localized within the prostate.

Rise in distant metastases upon prostate cancer diagnosis

Aresearch letter published in JAMA Oncology found an upward trend in the number of U.S. men who have distant metastases upon prostate cancer diagnosis.1

In 2007, 2.4% of men younger than 75 years had distant metastases upon diagnosis of prostate cancer, compared to 4% in 2013. The increase was also dramatic for men 75 years or older, with 6.6% presenting with distant metastases upon diagnosis in 2007, compared to 12% in 2013.

The data also showed an increase in the percentage of men with Gleason grade cancers of 8 or higher upon diagnosis. Prostate cancers with a Gleason grade of 8 or higher are more likely to grow and spread more quickly. In 2007, 11.9% of men 75 years and younger had Gleason grades 8 to 10 upon diagnosis, compared to 16.9% in 2013. Again, there was a steep incline for older men. In 2007, 25.2% of men 75 or older had Gleason grades 8 to 10 upon diagnosis, compared to 35.9% in 2013.

The study used data from the Surveillance, Epidemiology and End Results (SEER) database.

SPORE Project Genotyping to be Provided by CIDR

The URF congratulates Dr. Catalona and the other investigators involved in the SPORE project Germline Genetic Variants and the Failure of Active Surveillance for Prostate Cancer. The team’s application to the Center for Inherited Disease Research (CIDR) for genotyping 5,061 samples for the project was approved. CIDR will provide the genotyping at no cost, which will greatly help the project move forward.

Fewer men being treated for prostate cancer

Researchers at the University of Michigan found that the overall rate of men receiving treatment for prostate cancer declined by 42% from 2007 to 2012.2 This reflects a change in the screening process and efforts to decrease overdiagnosis and overtreatment.

However, while fewer men overall were being treated for prostate cancer, the rates of diagnosed men receiving treatment remained high. The study included data on 67,023 men newly diagnosed with prostate cancer. Nearly 75% of these men had initial curative treatment, such as surgery or radiation. Researchers compared the rates of men having initial surgery or radiation from 2007 to 2012 and found only 8% fewer overall were electing to have treatment. This indicates that most men diagnosed with prostate cancer were still not choosing active surveillance.

Looking ahead

Continuing research efforts strive to better identify which men are at highest risk of developing prostate cancer, and therefore would benefit the most from screening and treatment.

The prostate-specific antigen (PSA) test is a simple, low-cost blood test that looks for the presence of an antigen in a patient’s blood. Dr. Catalona led the groundbreaking study that led to the adoption of the PSA test for prostate cancer screening in 1991.

  1. JAMA Oncol. Published online December 29, 2016. doi:10.1001/jamaoncol.2016.5465
  2. Health Aff (Millwood). 2017 Jan 1;36(1):108-115. doi: 10.1377/hlthaff.2016.0739.

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