Advanced prostate cancer incidence continued to increase after USPSTF recommendation on testing
Incidence of regional and distant-stage prostate cancer has continued to increase among men aged 50 years and older in the United States, according to results of a retrospective study published in Journal of the National Cancer Institute.
“We don’t know the reason for the continued increase in advanced-stage prostate cancer,” Ahmedin Jemal, DVM, PhD, cancer epidemiologist and vice president of the Surveillance & Health Services Research Program at American Cancer Society, told Healio. “The increase, however, [occurred] following the U.S. Preventive Services Task Force recommendations against routine PSA testing for men aged 75 years or older in 2008 and for all men in 2012.”
Prior studies showed incidence of local-stage disease declined but increased for regional- and distant-stage disease soon after the USPSTF recommendations against PSA-based screening.
Jemal and colleagues sought to determine whether those patterns persisted over the longer term.
The researchers analyzed data from the U.S. Cancer Statistics Public Use Research Database to determine temporal trends in invasive prostate cancer incidence between 2005 and 2016 among men aged 50 years or older, stratified by disease stage, age group and race/ethnicity.
Investigators estimated annual percent change with joinpoint regression models.
Results showed that, for all races/ethnicities combined, incidence of local-stage disease declined starting in 2007 for men aged 50 years and older.
Incidence rates decreased by 6.4% (95% CI, 4.9-7.9) per year between 2007 and 2016 among men aged 50 to 74 years and by 10.7% (95% CI, 6.2-15%) per year between 2007 and 2013 among men aged 75 years and older before plateauing between 2013 and 2016.
Incidence of regional and distant-stage prostate cancer increased among both age groups during the study period. Rates of distant-stage disease increased by 2.4% (95% CI, 0.3-4.6) annually from 2008 to 2012 and by 5.6% (95% CI, 4.4-6.8) annually from 2012 to 2016 among men aged 50 to 74 years, and by 5.2% (95% CI, 4.2-6.1) annually between 2010 and 2016 among men aged 75 years and older.
Data were not adjusted to account for delays in reporting of cases, which served as a limitation to this study.
“These data illustrate the trade-off between higher screening rates and more early-stage disease diagnoses — possibly overdiagnosis and overtreatment — and lower screening rates and more late-stage disease,” Jemal said in a press release. “Several modeling studies, however, showed that the harms associated with higher PSA screening rates can be mitigated while preserving the benefit of screening through PSA-stratified strategies, including longer screening interval based on baseline PSA, higher PSA threshold for biopsy referral in older men, and restricting routine testing to men aged 70 years or younger.”
Researchers noted the study did not examine incidence after 2018, when the USPSTF changed its recommendations again to include screening as an option for men aged 55 to 69 years and advise against it for men aged 70 years or older. Registry data that would allow for analysis of how those most recent recommendations affected prostate cancer rates are not yet available. – by John DeRosier
For more information:
Ahmedin Jemal, DVM, PhD, can be reached at firstname.lastname@example.org.
Disclosures: All study authors are employed by the American Cancer Society. They report no relevant financial disclosures.