Studies find rates of PSA screening, incidence of early-stage prostate cancer declining

An editorial called for personalized screening strategies that are tailored to a man's individual risk and preferences.

Early-stage prostate cancer incidence and prostate-specific antigen (PSA)-based screening rates fell in men 50 years and older following release of recommendations against PSA-based screening, according to research.

A study, a research letter, and an editorial that appeared in the Nov. 17 the Journal of the American Medical Association (JAMA) examined the changes in PSA screening rates and prostate cancer incidence before and after the 2008 and 2012 U.S. Preventive Services Task Force (USPSTF) screening recommendations were released.

In the study, researchers examined trends in stage-specific prostate cancer incidence and PSA-based screening for men 50 years and older. Researchers determined newly diagnosed cases of prostate cancer per 100,000 men age 50 years and older by stage from 2005 through 2012 using data from 18 population-based Surveillance, Epidemiology, and End Results (SEER) registries. The PSA screening rate was determined by using National Health Interview Surveys.

Prostate cancer incidence per 100,000 in men 50 years and older (n=446,009 in SEER areas) was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012, researchers reported. Rates began decreasing in 2008. The largest decrease occurred between 2011 and 2012, from 498.3 (99% CI, 492.8 to 503.9) to 416.2 (99% CI, 411.2 to 421.2). The number of men 50 years and older diagnosed with prostate cancer nationwide declined from 213,562 men in 2011 to 180,043 men in 2012.

The percentage of men 50 years and older reporting PSA screening in the past 12 months was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013. Relative PSA screening rate and rate ratios (SRRs) increased between 2005 and 2008 (SRR, 1.10; 99% CI, 1.01 to 1.21) and then decreased between 2010 and 2013 (SRR, 0.82; 99% CI, 0.75 to 0.89). Similar screening patterns were found in those age 50 to 74 years and age 75 years and older.

“Using the most recent population-based incidence and nationally representative self-reported PSA screening data, we report reductions in early-stage prostate cancer incidence and PSA-based screening rates in men 50 years and older, coinciding with the 2012 USPSTF recommendation against PSA-based screening,” the authors write. “Longer follow-up is needed to see whether these decreases are associated with trends in mortality.”

In a research letter published in the same issue of JAMA, researchers reviewed PSA screening data from the 2000, 2005, 2010, and 2013 National Health Interview Survey to assess the prevalence and determinants of screening before and after the 2012 USPSTF recommendations.

The final study population included 20,757 men (4,698 in 2000, 5,111 in 2005, 4,598 in 2010, and 6,350 in 2013). The prevalence of PSA screening was 34% (95% CI, 33% to 36%) in 2000 and 2005. Between 2010 and 2013, the prevalence decreased from 36% (95% CI, 34% to 37%) to 31% (95% CI, 30% to 33%) overall. In a pooled analysis, survey year 2013 was associated with lower odds of PSA screening compared to 2010 (odds ratio [OR], 0.79; 95% CI, 0.71 to 0.88). However, significant declines were seen only in men younger than age 75 years (OR, 0.78; 95% CI, 0.70 to 0.88), not men age 75 years or older (OR, 0.85; 95% CI, 0.66 to 1.10). The largest declines were noted among men age 50 to 54 years (from 23% in 2010 [95% CI, 20% to 26%] to 18% in 2013 [95% CI, 15% to 21%]; OR, 0.71 [95% CI, 0.56 to 0.91]) and among men age 60 to 64 years (from 45% [95% CI, 41% to 49%] to 35% [95% CI, 32% to 39%]; OR, 0.69 [95% CI, 0.54 to 0.89]).

“The 2008 USPSTF recommendations against PSA screening in men aged 75 years or older have not been associated with changes in screening practices,” the authors wrote. “However, we found a decrease in the prevalence of PSA screening following the 2012 recommendations, particularly in men younger than 75 years.”

An editorial noted concerns about the decline in prostate cancer screening and prostate cancer incidence.

“Certainly, physicians have been overly aggressive in their approach to prostate cancer screening and treatment during the past 2 decades, but the pendulum may be swinging back the other way,” the editorial stated. “It is time to accept that prostate cancer screening is not an ‘all-or-none’ proposition and to accelerate development of personalized screening strategies that are tailored to a man's individual risk and preferences. By doing this, it should be possible to reach some consensus around this vexing problem and ultimately help men by stopping the swinging pendulum somewhere in the middle.”