"The government is spending more in Medicare, we are getting more people with prostate cancer, more deaths with prostate cancer, [and] more metastasis with prostate cancer. While it is so simple: today, PSA is still there," says Navin Shah, MD, MS, FACS, FICS, FACIP.
A recent study found a decrease in rates of prostate biopsy and an increase in rates of high-grade prostate cancer following a decision by the United States Preventive Services Task Force (USPSTF) to recommend against prostate-specific antigen (PSA) screening for men of all ages.1
The study retrospectively analyzed 1703 patients who underwent a prostate biopsy from 2010 to 2012 and 1006 patients who underwent a biopsy in 2018, 2019, and 2021. The 2 cohorts were stratified as Group A (having received a biopsy prior to USPSTF update on recommendations) and Group B (having received a biopsy after the USPSTF update on recommendations).
The total study cohort consisted of 76% Black patients, 14% White patients, and 11% other.
Data showed that after the USPSTF recommending against screening, the annual rate of prostate biopsy went down by 41% between the 2 cohorts, from 567 patients per year in Group A compared with 335 patients per year in Group B. Despite the 41% reduction in prostate biopsies, the total number of positive biopsies doubled.
Further, the investigators found that diagnosis of high-grade prostate cancer (Gleason sum score 7-10) increased from 51.5% in Group A compared with 59% in Group B. This marked an 8% increase in high-grade disease after the recommendation was issued. They also found a 64% decrease in digital rectal examinations and a 39% decrease in PSA screening between the 2 cohorts.
In an interview with Urology Times®, Navin Shah, MD, MS, FACS, FICS, FACIP, lead author of the study, commented on these findings, saying “Screening has gone down by 50%. The digital rectal examination is down by 60%. PSA screening is down by 41%...All [that] does is increase the prostate cancer, increase the metastasis, and increase the death.”
Findings from the study are consistent with recently released data from the American Cancer Society,2 which showed that rates of prostate cancer are on the rise for the first time in 2 decades, with the leading cause of this increase attributed to the diagnosis of advanced cases of disease.
The ACS data also showed that the prostate cancer incidence rate was 70% higher among Black men compared with White men, and the prostate cancer mortality rates for Black men are 2 to 4 times higher than for other racial groups.
“We’re doing a disservice and putting harm to Black people by not screening them. What I would say that 50 years and onwards, screening should be done. Let urologists decide. Now, things are different. Now, there is active surveillance. Now, there is parametric MRI biopsy. Now, we have got [prostate-specific membrane antigen] to see whether disease has spread or not,” said Shah, who is a urologist with MidAtlantic Urology Associates in Greenbelt, Maryland.
Shah also highlighted statistics on total spending for prostate cancer by the Centers for Medicare and Medicaid Services (CMS), saying, “In 2010, when we were doing screening, [CMS spent] $10.9 billion. Then in 2016, because no screening was done, more people got metastasis, [and] the cost increased to $15.3 billion. In 2020, [CMS spent] $20 billion. So I don't know who's benefiting. The government is spending more in Medicare, we are getting more people with prostate cancer, more deaths with prostate cancer, [and] more metastasis with prostate cancer. While it is so simple: today, PSA is still there.”
Based on these findings, Shah and the other study authors support annual PSA screening for all men over 50 years of age, especially for high-risk patients such as Black men or those with a family history of prostate cancer. They also recommend screening for men aged 70 to 80 years, given that they found that 33% of all positive prostate biopsy patients were in that age group. Currently, the USPSTF recommends against screening for men aged 70 and older.
“You must be aggressive right from the beginning to cure the prostate cancer, not wait till it spreads and [becomes] aggressive. There is no point in that,” concluded Shah.
1. Shah N, Ioffe V, Chang JC. Increasing aggressive prostate cancer. Can J Urol. 2022;29(6):11384-11390.
2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763.