Metastatic prostate cancer cases surge following USPSTF-recommended slowdown in screenings
Metastatic prostate cancer cases surged following the issuance of U.S. Preventive Services Task Force recommendations against routine screening for the disease, according to research published Monday.
It was back in 2008 that the influential panel of experts urged against regular prostate-specific antigen testing among men older than 75, which spread to all ages by 2012. USPSTF had expressed concerns about overdiagnosis and unnecessary treatment, while others countered that this could increase the occurrence of later stage results, experts wrote in JAMA Network Open.
The latter appears to be the case: Among men ages 45 to 74, incidences of metastatic prostate cancer stayed stable up until 2010. Starting then and through 2018, they leapt 41% while men 75 and older saw a 43% uptick following a period of decline. Increases persisted across all races and ages among both groups, researchers determined.
“This data is very important as it indicates the need to constantly reassess the impact of policy decisions,” Giovanni Cacciamani, MD, co-lead author of the study and an assistant professor of urology and radiology at the Keck School of Medicine, said in a statement. “Otherwise, we may see a continued rise in metastatic prostate cancer.”
University of Southern California, Los Angeles, researchers conducted their study using information from the Surveillance, Epidemiology, and End Results (SEER) database. A total of more than 836,000 individuals met the study criteria and were diagnosed with prostate cancer between 2004 to 2018 (the last year when data was available).
Cacciamani et al. noted that these marked increases came after declines in metastasized prostate cancer cases between 2004 to 2009. They also speculated that new imaging techniques with higher sensitivity may have contribute to these trends. Advances in molecular positron emission tomographic imaging, using novel contrast agents, have aided in detecting the disease. However, it is unlikely PET drove such increases, given that the imaging agent fluciclovine was not approved for U.S. use until 2017, among other reasons.
“Going forward, the expected increased use of these imaging modalities, as well as the anticipated inclusion of prostate-specific membrane antigen-based positron emission tomographic imaging, will likely further be associated with the incidence rates of metastatic and locally advanced PCa,” the authors advised.
USPSTF withdrew its previous objections in 2018, recommending personalized decision-making for screening men 55 to 69. That move, coupled with the emerging use of MRI to help avoid unnecessary prostate biopsies, may help to reverse these trends, one expert wrote in a corresponding editorial.
“Although the overall number of cancer diagnoses might not rebound to the level seen before the guideline change, the number of men discussing screening and receiving diagnoses of clinically important treatable cancers could increase,” Richard Hoffman, MD, with the University of Iowa’s Department of Internal Medicine, wrote March 14. “Achieving these outcomes might further reduce morbidity and mortality from PCa, reversing recent [metastatic prostate cancer] trends and minimizing the harms of overdiagnosis and overtreatment.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.