Fewer men are being screened, diagnosed, and treated for prostate cancer

May 21, 2018, Wiley
Micrograph showing prostatic acinar adenocarcinoma (the most common form of prostate cancer) Credit: Wikipedia

A new study reveals declines in prostate cancer screening and diagnoses in the United States in recent years, as well as decreases in the use of definitive treatments in men who have been diagnosed. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

There is considerable debate surrounding the value of with -specific antigen (PSA) testing, and the 2012 United States Preventive Services Task Force (USPSTF) recommendation against PSA testing lies at the center of this debate. This recommendation was made in part due to the potential harms—such as erectile dysfunction and urinary incontinence—associated with the treatment of clinically insignificant prostate with radical prostatectomy or radiation.

To examine the use of diagnostics and treatments for prostate cancer in the years surrounding the USPSTF recommendation, James Kearns, MD, of the University of Washington School of Medicine in Seattle, and his colleagues analyzed MarketScan claims, which capture more than 30 million privately insured patients in the United States. The team looked specifically at information related to PSA testing, , prostate cancer diagnosis, and definitive local treatment in men aged 40-64 years for the years 2008-2014. Men under age 65 years may benefit most from radiation or surgery for their prostate cancer because prostate cancer tends to cause problems for men many years after diagnosis.

In the analysis of approximately 6 million men with a full year of data, PSA testing, prostate biopsy, and prostate cancer detection declined significantly between 2009 and 2014, most notably after 2011. The prostate biopsy rate per 100 patients with a PSA test decreased over the study period from 1.95 to 1.52. Prostate cancer incidence per prostate biopsy increased over the study period from 0.36 to 0.39. Of new prostate cancer diagnoses, the proportion managed with definitive local treatment decreased from 69 percent to 54 percent. Both PSA testing and prostate cancer incidence decreased significantly after 2011.

"In addition to finding decreased , we found that fewer men were being diagnosed with prostate cancer, and even fewer men were being treated with surgery or radiation for their prostate cancer. This means that that they are likely choosing active surveillance for low risk prostate cancer," said Dr. Kearns. "This is important because active surveillance has been shown to be safe in many men, and it avoids problems associated with prostate cancer treatment, such as urinary incontinence and erectile dysfunction. Part of the controversy surrounding prostate cancer screening was that men who didn't need surgery or radiation for their prostate cancer were still undergoing those treatments. If those men are instead undergoing active surveillance of their low risk prostate cancer, then the harms of screening will be lower."

In an accompanying editorial, Christopher Filson, MD, MS, of Emory University School of Medicine notes that additional research is needed to determine which men will gain the most value from screening and to identify and correct gaps in the delivery of prostate cancer care to minimize overtreatment while abrogating the incidence of in the future. "The key will be performing PSA screening—in addition to biopsies and prostate cancer —more intelligently, not more frequently," he writes.

Explore further: Expert panel highlights patient choice for prostate cancer screen (Update)

More information: Christopher P. Filson, Moving toward a more rational, evidence-based approach to PSA screening, diagnosis, and treatment of prostate cancer, Cancer (2018). DOI: 10.1002/cncr.31332

Related Stories

Expert panel highlights patient choice for prostate cancer screen (Update)

May 8, 2018
(HealthDay)—More men could receive PSA blood tests for prostate cancer under revised guidelines released Tuesday by the nation's leading panel on preventive medicine.

What men should know about new prostate cancer screening guidelines

April 17, 2017
Men ages 55 to 69 should talk with their health care provider about prostate-specific antigen (PSA)-based screening for prostate cancer. That's according to new recommendations from the U.S. Preventive Services Task Force.

Prostate cancer tied to higher colorectal cancer risk

March 1, 2016
(HealthDay)—The risk of colorectal cancer is increased after a diagnosis of prostate cancer, according to a study published online Feb. 25 in Cancer.

Are men with a family history of prostate cancer eligible for active surveillance?

April 6, 2017
Active surveillance—careful monitoring to determine if or when a cancer warrants treatment—is an increasingly prevalent choice for prostate cancer, but it's unclear if the strategy is appropriate for men with a family ...

Surveillance biopsy timing not tied to reclassification

April 22, 2017
(HealthDay)—Timing of the first active surveillance biopsy is not associated with increased adverse reclassification of prostate cancer, according to a study published in the April issue of The Journal of Urology.

PSA screening significantly reduces the risk for death from prostate cancer

September 5, 2017
After differences in implementation and settings were accounted for, two important prostate cancer screening trials provide compatible evidence that screening reduces prostate cancer mortality. These findings suggest that ...

Recommended for you

Immunotherapy combo not approved for advanced kidney cancer patients on the NHS

December 14, 2018
People with a certain type of advanced kidney cancer will not be able to have a combination of two immunotherapy drugs on the NHS in England.

New drug seeks receptors in sarcoma cells, attacks tumors in animal trials

December 13, 2018
A new compound that targets a receptor within sarcoma cancer cells shrank tumors and hampered their ability to spread in mice and pigs, a study from researchers at the University of Illinois reports.

Surgery unnecessary for many prostate cancer patients

December 13, 2018
Otherwise healthy men with advanced prostate cancer may benefit greatly from surgery, but many with this diagnosis have no need for it. These conclusions were reached by researchers after following a large group of Scandinavian ...

Combining three treatment strategies may significantly improve melanoma treatment

December 12, 2018
A study by a team led by a Massachusetts General Hospital (MGH) investigator finds evidence that combining three advanced treatment strategies for malignant melanoma—molecular targeted therapy, immune checkpoint blockade ...

Researchers use computer model to predict prostate cancer progression

December 12, 2018
An international team of cancer researchers from Denmark and Germany have used cancer patient data to develop a computer model that can predict the progression of prostate cancer. The model is currently being implemented ...

New insight into stem cell behaviour highlights therapeutic target for cancer treatment

December 12, 2018
Research led by the University of Plymouth and Technische Universität Dresden has identified a new therapeutic target for cancer treatment and tissue regeneration – a protein called Prominin-1.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.