A Trend Toward Aggressive Prostate Cancer

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• The 2012 United States Preventive Services Task Force (USPSTF) issued recommendations against routine prostate cancer (PCa) screening.
• This study investigates the impact of these guidelines on PCa characteristics identified through prostate biopsies (Pbx).

Purpose of the Study:

• To compare prostate biopsy characteristics before and after the 2012 USPSTF PCa screening guidelines.
• To determine if the USPSTF recommendations affected PCa detection rates and tumor aggressiveness.

Main Methods:

• Retrospective comparative analysis of 1703 patients biopsied from 2010-2012 (Group A) and 383 (2018) + 310 (2019) patients (Groups B & C).
• Data collected included patient demographics, serum prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings, and Gleason sum score (GSS).
• Analysis focused on trends in biopsy rates, positive biopsy rates, PSA levels, and high-grade PCa detection.

Main Results:

• A decrease in annual prostate biopsies was observed post-2012 guidelines (567/year to 310-383/year).
• Despite fewer biopsies, the annual positive biopsy rate increased (134/year to 175-201/year).
• There was a significant increase in high-grade PCa (GSS 7-10) diagnoses (51.5% to 60.0-60.5%) and elevated PSA levels (≥10 ng/mL) across all groups.

Conclusions:

• The 2012 USPSTF recommendations have led to decreased PCa screening, with a concurrent rise in diagnosed high-grade PCa.
• Older men (70-80 years) and Black men showed increasing trends in high PSA levels and high-grade tumors.
• Results support the need for aggressive PCa screening in high-risk populations, including Black men, those with a family history, and older healthy men.