USPSTF Recommendation Against PSA Screening vs. Stage and Cancer-Specific Mortality in Localized Prostate Cancer

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• The 2012 US Preventive Services Task Force recommendation against prostate-specific antigen (PSA) screening led to changes in prostate cancer (PCa) outcomes.
• The impact of this recommendation on cancer-specific mortality (CSM) in localized PCa remains unevaluated.

Purpose of the Study:

• To assess the effect of the recommendation against PSA screening (RAPS) on cancer-specific mortality (CSM) in localized prostate cancer.
• To analyze trends in CSM following the RAPS introduction.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021) for patients treated with radiotherapy (RT) or radical prostatectomy (RP) for localized PCa.
• Employed least-squares linear regression for time trend analysis and multivariable Cox regression to evaluate the association between RAPS and PCa-mortality.

Main Results:

• For patients under 75, the RAPS era showed a 1.2-fold higher CSM compared to the pre-RAPS era (1.9% vs 1.6%).
• This increased CSM was significant for both RP (1.3-fold) and RT (1.1-fold) treated patients under 75.
• For patients aged 75 and older, the RAPS era did not show a significant increase in CSM.

Conclusions:

• The introduction of RAPS by the USPSTF is associated with a 1.2-fold increase in CSM for localized PCa patients under 75.
• No significant increase in CSM was observed for patients aged 75 and older following RAPS.
• Time trend analysis indicates a worsening negative effect of RAPS on CSM over time, particularly since its introduction.