PSA Screening Decline Implicated in Rise of Metastatic PCa at Diagnosis

Recent increases in metastatic prostate cancer (PCa) at diagnosis in the United States may be due at least in part to reductions in PSA screening, according to study findings presented at the virtual 2021 Genitourinary Cancers Symposium.

To address the overtreatment of PCa and its significant quality of life implications, the US Preventive Services Task Force (USPSTF) did not recommend PSA screening in 2008 and 2012, the study’s authors noted. They examined whether reductions in PSA screening were responsible for an increased incidence of metastatic PCa in the United States by associating longitudinal variations across individual states in PSA screening with their incidence of metastatic PCa at diagnosis from 2002 to 2016.

Vidit Sharma, MD, a VA Health Services Research Fellow in Urologic Oncology at the University of California, Los Angeles, and colleagues used the North American Association of Central Cancer Registries for each state to obtain data on the age-adjusted incidences of metastatic PCa at diagnosis per 100,000 men. They also extracted weighted PSA screening estimates for each state from the Behavioral Risk Factor Surveillance System, which collects this information for men at least 40 years of age every 2 years from 2002 onward.

Overall, from 2008 to 2016, the mean percentage of men undergoing PSA screening decreased from 61.8% to 50.5%, whereas the mean age-adjusted incidence of metastatic PCa at diagnosis increased from 6.4 to 9.0 per 100,000 men. A random-effects linear regression model showed that longitudinal reductions in PSA screening across states were associated with increased incidences of metastatic PCa, Dr Sharma’s team reported. States with larger declines in PSA screening had bigger increases in the incidence of metastatic PCa at diagnosis, they noted.

The investigators concluded that their study “strengthens the epidemiologic evidence that reductions in PSA screening may explain some of the recent increase in metastatic prostate cancer at diagnosis in the United States. The trend of rising metastatic disease at diagnosis is a worrisome consequence that needs attention. Thus, we support shared-decision making policies, such as the 2018 USPSTF update, that may optimize PSA screening utilization to reduce the incidence of metastatic prostate cancer in the United States.”

Reference

Sharma V, Venkataramana A, Comulada WS, Litwin MS, Saigal C. Association of reductions in PSA screening across states with increased metastatic prostate cancer in the United States. Presented at the virtual 2021 Genitourinary Cancers Symposium, February 11, to 13. Abstract 228.