Recent Changes in Prostate Cancer Screening Practices and Epidemiology

Area of Science:

• Urology
• Oncology
• Preventive Medicine

Background:

• Prostate specific antigen (PSA) screening significantly impacts prostate cancer epidemiology.
• While reducing mortality, PSA screening leads to overdiagnosis and overtreatment of indolent cancers.
• The U.S. Preventive Services Task Force (USPSTF) issued recommendations in 2012 against routine PSA screening.

Purpose of the Study:

• To review changes in PSA testing, prostate biopsy rates, and prostate cancer incidence and stage at presentation since the 2012 USPSTF recommendations.
• To assess the impact of updated screening guidelines on prostate cancer detection and management.

Main Methods:

• Literature search for studies on USPSTF recommendations' effects on PSA screening and prostate cancer incidence in the U.S. up to December 2016.
• Analysis of 26 original studies published after the 2012 USPSTF recommendations.

Main Results:

• A decrease in PSA testing and prostate biopsies was observed from 2012 to 2016.
• The incidence of localized prostate cancer (low, intermediate, and high risk) declined.
• Early data suggest a potential shift towards detecting higher-burden disease at presentation.

Conclusions:

• The observed decline in screening and diagnosis raises concerns about reversing decades of improvement in prostate cancer mortality.
• Alternative screening strategies should prioritize shared decision-making, preserve survival benefits, enhance specificity, and promote active surveillance for low-risk cancers.