Early-stage PCa incidence drops post-USPSTF

Incidence rates for early-stage prostate cancer in men 50 years of age and older dropped 6% from 2012 to 2013, according to a research letter published online in JAMA Oncology (Aug. 18, 2016).

The authors also reported a 19% decline in early-stage prostate cancer from 2011 to 2012.

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Simultaneously, PSA testing rates in the U.S. between 2010 and 2013 decreased from 36.8% to 29.9% in men 50 to 74 years of age and from 43.1% to 36.3% in men 75 years of age and older.

The disturbing trend in early-stage prostate cancer detection follows the U.S. Preventive Services Task Force (USPSTF) recommendations against routine PSA testing to all men, which USPSTF released in draft form in 2011 and final form in 2012.

“The incidence of early-stage prostate cancer continues to decrease in the U.S. following the USPSTF recommendation against routine PSA testing, albeit at slower pace. I think the association between the decrease in early-stage prostate cancer incidence rates and the U.S. Preventive Services Task Force recommendation to limit PSA testing is very strong. I cannot think of any other explanations for the declining trend,” said lead author Ahmedin Jemal, DVM, PhD, of the American Cancer Society, Atlanta.

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The authors referred to data on invasive prostate cancer diagnosed from 2005 through 2013, in men who were 50 years of age and older and lived in 18 Surveillance, Epidemiology and End Results (SEER) registries, covering about 28% of the U.S. population.

Next: What the authors found

They found that from 2012 to 2013, localized/regional-stage prostate cancer incidence rates per 100,000 men fell from 356.5 to 335.4 in men 50 to 74 years of age and from 379.2 to 353.6 in men 75 years of age and older.

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Whether this pattern will lead to increases in distant-stage disease diagnoses and prostate cancer death remains to be seen. So far, there is no increase in rates of distant-stage disease or in prostate cancer mortality. That finding might be a reflection of timing, according to Dr. Jemal.

“Any evidence for increase in rates of distant-stage prostate cancer or prostate cancer mortality due to the reduction in detection of early-stage disease may not be apparent for the next 5 to 10 years because of the slow-growing nature of the tumor,” he said.

Dr. Jemal said he and his colleagues plan to continue to examine the incidence trend every year.

As for how these findings might affect urology practice or the way urologists educate their patients and referring primary care physicians, Dr. Jemal said the American Cancer Society and the AUA recommend that PSA testing should take place after patients have been informed about the benefit and the risk of PSA testing.

“Doctors play a major role in making this happen,” Dr. Jemal said.

The American Cancer Society sponsored the study.

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