Top Takeaways from ASCO: Prostate cancer screening

CHICAGO — The revised guidelines for prostate cancer screening with PSA testing issued by the U.S. Preventive Services Task Force in 2012 reduced the number of screenings among men aged 75 years or older, but not in relation to overall rates.

“With the most recent changes in 2012, the U.S. Preventive Services Task Force (USPSTF) essentially recommended against screening any men for prostate cancer with a digital rectal exam or PSA for men of average risk of getting prostate cancer. They gave it a grade D recommendation,” Simon Kim, MD, MPH, assistant professor of urology and urologic oncology at University Hospital Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio, and a study investigator, told Healio.com. “[There were] two trials that showed really mixed level evidence [regarding screening]. I think the controversy is because one trial showed no benefit and the other did.”

Simon Kim

Kim and colleagues presented findings from a population-based cohort at the ASCO 2015 annual meeting. Using information collected from Optum Labs Data Warehouse, a large private health insurance claims database, they identified men aged 40 to 80 years who underwent prostate cancer screening. In a cohort of 11.6 million eligible enrollees, 2.9 million men (25%) were identified who had screening performed between 2008 and 2013. The majority of these patients were white, aged 50-59 years and lived in the Southern census region.

The rate at which men completed PSA screening was consistent from 2008 to 2013 (190.4 per 1,000 member years vs. 196.4 per 1,000 member years, respectively; P = .66). Screening rates remained “relatively stable” for men aged 50-74 years, according to the study results, and no difference was noted between racial groups or geographic regions over time. However, a “marked decrease” in screening among enrollees aged over 75 years was noted, from 201.5 per 1,000 member-years in 2008 to 124.1 per 1,000 member-years in 2013 (P = .04).

“One positive impact of the reduction in prostate cancer screening in patients with advanced age is that there will be [fewer] unnecessary biopsies and potential complications of biopsies, as well as potentially reducing the rate of over-diagnosis of prostate cancer,” Kim said. “I think that all urologists, radiation oncologists, medical oncologists and primary care providers need to understand that there is an over-diagnosis of prostate cancer. In patients who are older who probably will not benefit from treatment, it’s beneficial that you do not need to screen patients … [as] they’re unlikely to die of their disease.” – by Julia Ernst, MS

Reference:

Kim SP, et al. Abstract 5065.

Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.

Disclosure: Kim reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.