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

Journal name:
Nature Reviews Urology
Volume:
14,
Pages:
26–37
Year published:
DOI:
doi:10.1038/nrurol.2016.251
Published online

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.

At a glance

Figures

  1. Age-adjusted prostate cancer incidence rates in men of all races between 1975 and 2013.
    Figure 1: Age-adjusted prostate cancer incidence rates in men of all races between 1975 and 2013.

    The graph reflects the effect of the availability and use of the PSA test on early detection and diagnosis of prostate cancer from the SEER 9 Database. Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database.

  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 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.

    Trends in the graph are similar to those depicted in Fig. 1, but the effect of the use of the PSA test is most noticeable in men aged >65 years from the SEER 9 Database. Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database.

  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.
    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.

    The temporal trends in prostate cancer incidence, which are reflective of changes in PSA testing over time, are seen in all ethnicities in the SEER 9 Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database.

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Affiliations

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

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

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

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

    • Monique J. Roobol

Contributions

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.

Competing interests statement

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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Author details

  • Katherine Fleshner

    Katherine Fleshner studied pharmacology at McGill University, Montreal, Canada and is now a first-year medical school student at Schulich School of Medicine and Dentistry, University of Western Ontario, Canada, undertaking a Fleshner's Summer student internship at the Departments of Surgery and Urology and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.

  • Sigrid V. Carlsson

    Sigrid V. Carlsson is Assistant Attending Epidemiologist at the Departments of Surgery and Epidemiology and Biostatistics at Memorial Sloan Kettering Cancer Center, New York, USA. She is an Associate Professor of Experimental Urology affiliated with the Institute of Clinical Sciences at Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. As well as her medical degree, she holds a PhD in urology, both from Gothenburg University and has a MPH in quantitative methods from Harvard School of Public Health, Boston, USA. She is an investigator of the Swedish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

  • Monique J. Roobol

    Monique J. Roobol is an Epidemiologist and Associate Professor at the Department of Urology at Erasmus University Medical Center, Rotterdam, Netherlands. She is the principal investigator of the Rotterdam section of the ERSPC, the web-based study on active surveillance PRIAS, and the Movember GAP Consortium on Active Surveillance. She has coauthored more than 250 publications in peer-reviewed journals.

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