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A Trend Toward Aggressive Prostate Cancer.

Navin Shah1, Vladimir Ioffe2

  • 1Mid-Atlantic Urology Associates Greenbelt, MD.

Reviews in Urology
|November 26, 2020
PubMed
Summary
This summary is machine-generated.

The 2012 United States Preventive Services Task Force (USPSTF) guidelines led to decreased prostate cancer (PCa) screening, resulting in fewer biopsies but more diagnoses of high-grade PCa. Aggressive screening is recommended for high-risk individuals.

Keywords:
Black menElderly menProstate cancerProstate-specific antigen screeningUnited States Preventive Services Task Force

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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.