Histologic Changes in Prostate Cancer Detected Subsequent to the 2012 United States Preventive Services Task Force...

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• The United States Preventive Services Task Force (USPSTF) issued a Grade D recommendation against prostate-specific antigen (PSA) screening for prostate cancer.
• This recommendation potentially impacts prostate cancer detection rates and disease characteristics at diagnosis.

Purpose of the Study:

• To evaluate changes in prostate cancer histopathology and biopsy outcomes following the USPSTF's 2012 recommendation against PSA screening.
• To compare prostate biopsy data from 2011 (baseline) with data from 2013-2015.

Main Methods:

• Retrospective review of 10,944 prostate biopsies performed between 2011 and 2015 in a large urology group practice.
• Exclusion of 2012 as a transition year for data analysis.
• Comparison of biopsy outcomes (positive rates, Gleason Grade Group) between the baseline year (2011) and subsequent years (2013-2015).

Main Results:

• Positive prostate biopsy rates increased from 39.1% at baseline to 45.2% in 2015 (P < 0.01).
• A significant shift towards more aggressive cancers was observed, with the absolute number of patients diagnosed with Gleason Grade Group 4 or 5 increasing annually from 155 at baseline to 285 in 2015 (P < 0.05).
• These trends were independent of age or racial demographics, with Black men comprising 16% of the cohort.

Conclusions:

• The USPSTF recommendation against PSA screening was associated with an upward grade migration and increased volume of prostate cancers in a real-world clinical setting.
• These findings highlight potential adverse consequences of reduced screening, possibly leading to more advanced cancer diagnoses.
• Continued reductions in cancer detection may worsen these observed trends in the United States.