Prostate-Specific Antigen Screening and Recent Increases in Advanced Prostate Cancer

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• National recommendations in 2012 led to decreased prostate-specific antigen (PSA) utilization.
• An increasing incidence of metastatic prostate cancer has been observed in the United States.
• The magnitude of this increase relative to reduced screening is not fully understood.

Purpose of the Study:

• To compare the observed incidence of metastatic prostate cancer with projected increases based on screening models.
• To assess the consistency between reduced PSA screening and the observed rise in metastatic disease.

Main Methods:

• Utilized data from the Surveillance, Epidemiology, and End Results (SEER) program for observed metastatic prostate cancer incidence.
• Compared observed rates with projections from two models simulating disease natural history, screening, and diagnosis.
• Analyzed trends from 2013 onwards, contrasting continued vs. discontinued screening scenarios.

Main Results:

• The observed rate of new metastatic prostate cancer cases in 2017 was 44%-60% of the projected increase under discontinued screening compared to continued screening.
• This suggests the observed increase in metastatic prostate cancer incidence is consistent with the impact of reduced screening.
• The findings highlight a plausible link between decreased screening and increased metastatic disease.

Conclusions:

• The observed rise in metastatic prostate cancer incidence appears consistent with the expected impact of reduced prostate-specific antigen screening.
• While not establishing causality, the data suggest decreased screening plays a role in the observed trend.
• Further research may be warranted to confirm the causal relationship and inform screening guidelines.