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Incidence of higher-risk prostate cancer has increased since 2011
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The number of men diagnosed with at least intermediate-risk prostate cancer increased by 6% from 2011 to 2013, according to study results presented at the Genitourinary Cancers Symposium.
The US Preventive Services Task Force recommends against routine-based PSA prostate cancer screening for healthy men regardless of age. In 2009, the USPSTF issued that recommendation for men aged 75 years or older. In 2011, the task force issued draft guidance expanding that recommendation to include all men, and it finalized that recommendation in May 2012.
A study by Timothy E. Schultheiss, PhD, professor and director of radiation physics at City of Hope in Duarte, California, and colleagues was the first to measure changes in prostate cancer presentation since the USPSTF made these recommendations.
“If you don’t screen the people, then when they do show up with prostate cancer, the horse is out of the barn,” Schultheiss said during a press conference. “They’re more likely to be at intermediate risk because, by missing early disease, then you are going to catch it when it’s palpable or causing symptoms. That, of course, makes it much more difficult to treat.”
The correlation between increased incidence of higher-risk prostate cancer and the USPSTF recommendation remains speculative. However, Schultheiss and colleagues indicated the data they used from the National Oncology Data Alliance — which collects information from diagnosed cancer cases at more than 150 hospitals in the United States — does show a statistical shift not long after the initial USPSTF recommendation.
Their analysis included 87,562 men diagnosed with prostate cancer between 2005 and June 2013.
The proportion of men with a blood PSA level of more than 10 — the benchmark for intermediate- or high-risk prostate cancer — remained relatively stable between 2005 and 2011, ranging from 70% to 73%.
However, the percentage increased by approximately 3% each year between 2011 and 2013 (P = .0004), and researchers said they observed no “evidence of a plateau.” During that time, the percentage of men aged at least 75 years who presented with PSA greater than 10 increased at a rate nearly twice that of the overall population.
Schultheiss and colleagues estimated this would translate to an additional 14,000 higher-risk prostate cancer diagnoses in the United States in 2014 compared with 2011.
When the researchers took approximate 10-year survival rates for low-risk, intermediate-risk and high-risk prostate cancers into account, they determined the fact more patients present with later-stage disease would lead to an additional 1,400 deaths from prostate cancer in 2014.
The researchers indicated they intend to update the results of their analysis as new registry data become available.
“The fundamental thing that we would like to see taken away from this is that we need to be intelligent about who we screen and who we treat,” Schultheiss said. “We’re not suggesting that everyone be screened, but we’re not suggesting that no one be screened, either. That’s a fairly extreme position, we think. There are other positions out there that are intermediate that try to use risk background as a criterion for who gets screened.” – by Anthony SanFilippo
Reference:
Hall MD, et al. Abstract 143. Presented at: Genitourinary Cancers Symposium; Feb. 26-28, 2015; Orlando, Florida.
Disclosure: The researchers report no relevant financial disclosures.
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Charles J. Ryan, MD
This study, although preliminary, adds new insight to the ongoing debate on the risks and benefits of PSA screening for prostate cancer. These findings alone do not warrant changes in physician practice, but they do suggest that men should continue to be encouraged to talk with their doctors about screening to decide whether it is appropriate for them.Click Here to Manage Email Alerts