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Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and

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The US Preventive Services Task Force recommended against prostate-specific antigen (PSA) screening. Post-recommendation, the risk of high-grade prostate cancer increased significantly, despite no change in metastatic disease rates.

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Area of Science:

  • Urology
  • Oncology
  • Preventive Medicine

Background:

  • US Preventive Services Task Force issued a grade D recommendation against PSA screening in May 2012.
  • This recommendation advised against prostate cancer screening for all age groups.

Purpose of the Study:

  • To compare prostate cancer characteristics before and after the 2012 screening recommendation.
  • To analyze institutional data and conduct a pooled analysis with other primary data sources.

Main Methods:

  • Incident prostate cancer diagnoses from 2007-2016 were identified.
  • Multivariable log binomial regression assessed the risk of metastasis, high-grade disease (≥Gleason Group 4), and high D'Amico risk disease.
  • A meta-analysis of primary data studies was performed.

Main Results:

  • The risk of metastatic disease at diagnosis did not significantly differ pre- vs. post-recommendation.
  • The risk of high-grade prostate cancer (≥Gleason Group 4) was 1.58 times higher post-recommendation (p=0.007) at the institutional level.
  • Pooled analysis confirmed increased risk for high-grade disease (RR 1.5, p<0.001) and high D'Amico risk disease (RR 1.29, p=0.006) post-recommendation.

Conclusions:

  • The 2012 recommendation against PSA screening was associated with an increased risk of high-grade prostate cancers.
  • This increase in high-grade diagnoses was observed both locally and in aggregated data.
  • Metastatic disease rates did not change, suggesting a potential impact on early detection of aggressive cancers.