Application of the 2013 American Urological Association early detection of prostate cancer guideline: Who will we miss?
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The American Urological Association (AUA) published new prostate cancer (CaP) screening guidelines in 2013. We apply the guidelines to a retrospective cohort to compare tumor characteristics of those no longer recommended for screening with those who remain screening candidates.
We identified cases of screening detected CaP (stage cT1c) in the Surveillance Epidemiology and End Results database from October 2005 to December 2010. The 2013 AUA Guidelines were retrospectively applied to the cohort. Men were categorized into three groups for comparison based on whether or not they would now be recommended for CaP screening (Unscreened, Young Unscreened, and Screened). We compared clinical and pathological characteristics of CaP across study groups.
A total of 142,382 men were identified. Screening would no longer be recommended for 40,160. Those no longer recommended for screening had higher median PSA (6.4 vs. 5.8 ng/mL, p < 0.01), more Gleason 7 and ≥8 CaP on prostate biopsy (36.4 vs. 34.8 %, p < 0.001; 12.4 vs. 9.2 %, p < 0.001, respectively) and slightly more Gleason ≥8 CaP (9.0 vs. 7.5 %, p = 0.03), and T3 tumors (17.3 vs. 16.5 %, p = 0.01) at prostatectomy. Nodal and distant metastasis rates were clinically equivalent among men screened and unscreened. Subgroup analysis of young patients (40–54 years old) no longer recommended for screening identified intermediate or high-risk Gleason scores at prostatectomy 57.6 % of the time.
Features of CaP in men no longer recommended for routine screening are largely equivalent to if not worse than those in screened men.
KeywordsProstate cancer Screening Guidelines Prostate-specific antigen
Special thanks to Mr. John Cashy for assistance with statistical analysis and data acquisition.
Conflict of interest
The authors certify that there is no actual or potential conflict of interest in relation to this article.
All patient data in this study were acquired through the fully de-identified SEER database, which is collected and disseminated via the National Cancer Institute in a manner compliant with the 1964 Declaration of Helsinki and later amendments.
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