The incidence of metastatic prostate cancers at prognosis elevated as prostate-specific antigen (PSA) screenings throughout U.S. states decreased, registry information present.
Between 2008 and 2016, the age-adjusted total imply proportion of prostate cancers that had been metastatic at prognosis elevated considerably from 6.4 to 9.0 per 100,000 males. Throughout the identical interval, the general imply proportion of males present process PSA screening decreased from 61.8% to 50.5%, Vidit Sharma, MD, reported in a poster session on the 2021 Genitourinary Cancers Symposium (Summary 228).
A random-effects linear regression mannequin demonstrated that longitudinal reductions throughout states in PSA screening had been certainly related to elevated age-adjusted incidence of metastatic prostate most cancers, stated Sharma, the lead writer of the examine and a well being providers fellow in urologic oncology on the College of California, Los Angeles.
The regression coefficient per 100,000 males was 14.9, confirming that states with higher declines in screening had higher will increase in prostate cancers that had been metastatic at prognosis, he added, noting that, “total, variation in PSA screening defined 27% of the longitudinal variation in metastatic illness at prognosis.”
Sharma and colleagues had reviewed North American Affiliation of Central Most cancers Registries information from 2002 to 2016 for every state and extracted survey-weighted PSA screening estimates from the Facilities for Illness Management and Prevention’s Behavioral Threat Issue Surveillance System. The researchers famous extensive variations in screening throughout states, however they stated across-the-board declines had been evident starting in 2010, marking a “worrisome consequence that wants consideration.”
Robert Dreicer, MD, deputy director of the College of Virginia Most cancers Middle, Charlottesville, agreed, noting in a press assertion that the findings counsel diminished PSA screening might come at the price of extra males presenting with metastatic illness.
“Sufferers ought to talk about the dangers and advantages related to PSA screening with their physician to establish the very best strategy for them,” Dreicer stated.
PSA screening has been proven to scale back prostate most cancers metastasis and mortality, however screening has additionally been linked to overdiagnosis and overtreatment of prostate most cancers. Because of this, the U.S. Preventive Companies Job Drive (USPSTF) “discovered inadequate proof to suggest PSA screening in 2008 and later really useful in opposition to PSA screening in 2012,” Sharma stated.
A number of research subsequently confirmed an increase in metastatic prostate most cancers prognosis, however the position of PSA screening reductions in these findings was unclear. In 2018, the USPSTF up to date its suggestions, stating that males aged 55-69 years ought to make “a person choice about whether or not to be screened after a dialog with their clinician concerning the potential advantages and harms.”
The duty drive really useful in opposition to PSA screening in males aged over 70 years.
The present examine “strengthens the epidemiological proof that reductions in PSA screening could also be answerable for not less than among the enhance in metastatic prostate most cancers diagnoses,” Sharma stated. He added that he and his coauthors assist shared decision-making insurance policies to optimize PSA screening approaches to scale back the incidence of metastatic prostate most cancers, akin to these really useful within the 2018 USPSTF replace.
Sharma disclosed analysis funding from the Veterans Affairs Well being Companies Analysis & Improvement Fellowship. He and his colleagues had no different disclosures.
This text initially appeared on MDedge.com, a part of the Medscape Skilled Community.