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The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

Nature Reviews Urology volume 14, pages 26–37 (2017)Cite this article

Subjects

Key Points

  • In 2012, the United States Preventive Services Task Force (USPSTF) issued a Grade D (against screening) recommendation for PSA screening for prostate cancer

  • Rates of PSA screening, prostate biopsy and overall prostate cancer incidence declined in the first few years after the recommendation, with a shift towards higher grade and stage of prostate tumours at the time of detection

  • Despite the recommendation, some physicians report ongoing willingness to screen appropriately selected men, and many men report that they intend to continue to ask for the PSA test from their doctor

  • Increased follow-up durations are needed in order to understand whether the decreased rates of PSA screening will effect prostate cancer metastasis and mortality

Abstract

Guidelines regarding recommendations for PSA screening for early detection of prostate cancer are conflicting. In 2012, the United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men aged ≥75 years in 2008 and for men of all ages in 2012. Understanding temporal trends in rates of screening before and after the 2012 recommendation in terms of usage patterns in PSA screening, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has influenced physician's and men's attitudes about PSA screening and subsequent ordering of other screening tests is essential within the scope of prostate cancer screening policy. Since the 2012 recommendation, rates of PSA screening decreased by 3–10% in all age groups and across most geographical regions of the USA. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a shift towards tumours being of higher grade and stage upon detection. Despite the recommendation, some physicians report ongoing willingness to screen appropriately selected men, and many men report intending to continue to ask for the PSA test from their physician. In the coming years, we expect to have an improved understanding of whether these decreased rates of screening will affect prostate cancer metastasis and mortality.

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Figure 1: Age-adjusted prostate cancer incidence rates in men of all races between 1975 and 2013.
Figure 2: Age-adjusted prostate cancer incidence rates in the Surveillance, Epidemiology and End Results (SEER) database by age at diagnosis from 1975 to 2013 in the USA.
Figure 3: Age-adjusted prostate cancer incidence rates in the Surveillance, Epidemiology and End Results (SEER) database in men of all ages by race/ethnicity, from 1975 to 2013 in the USA.

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Acknowledgements

S.V.C. is supported in part by a Cancer Center Support Grant from the National Cancer Institute made to Memorial Sloan Kettering Cancer Center (P30-CA008748) and the David H. Koch Fund for Prostate Cancer Research, as well as a postdoctoral research grant from AFA Insurance.

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Authors and Affiliations

  1. Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, N6A 5C1, Ontario, Canada

    Katherine Fleshner

  2. Department of Surgery and Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, 10017, New York, USA

    Sigrid V. Carlsson

  3. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Bruna Stråket 11B, Göteborg, 41345, Sweden

    Sigrid V. Carlsson

  4. Department of Urology, Erasmus Medical Center, office Na-1706, Wytemaweg 80, Rotterdam, 3015 CN, Netherlands

    Monique J. Roobol

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M.J.R and S.V.C. researched data for the article. All authors made substantial contributions to discussion of content, writing, and review and editing of manuscript before submission.

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M.J.R. is on the advisory board of OPKO. K.F. and S.V.C. declare no conflicts of interest.

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Fleshner, K., Carlsson, S. & Roobol, M. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 14, 26–37 (2017). https://doi.org/10.1038/nrurol.2016.251

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