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World Journal of Urology

, Volume 37, Issue 3, pp 489–496 | Cite as

Unintended consequences of decreased PSA-based prostate cancer screening

  • Thomas AhleringEmail author
  • Linda My Huynh
  • Kamaljot S. Kaler
  • Stephen Williams
  • Kathryn Osann
  • Jean Joseph
  • David Lee
  • John W. Davis
  • Ronney Abaza
  • Jihad Kaouk
  • Vipul Patel
  • Isaac Yi Kim
  • James Porter
  • Jim C. Hu
Original Article

Abstract

Background

In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality.

Materials and methods

To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching.

Results

Compared to the 4-year average pre-(Oct. 2008–Sept. 2012) versus post-(Oct. 2012–Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1–5.8 ng/mL) and mean age (60.8–62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2–17.1%) while high-grade GS 8 + cancers increased (8.4–13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement.

Conclusions

All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.

Keywords

Prostate cancer Screening USPSTF recommendation High risk 

Abbreviations

PSA

Prostate-specific antigen

USPSTF

United States Preventive Services Task Force

GS

Gleason score

RP

Radical prostatectomy

SVI

Seminal vesicle invasion

LNI

Lymph node involvement

BCR

Biochemical recurrence

PCSM

Prostate cancer-specific mortality

Notes

Acknowledgements

Special thanks to the Urology research coordinators, fellows, and students who have contributed to data collection and collation: Erica Huang, Anthony Warner, Omesh Ranasinghe, Bonita Powell, Kellie McWilliams, Mary Achim, Pascal Mouracade (MD), Tadzia Harvey, Brian Shinder (MD). In support of Dr. Edward and Arthur Lui (MD) and in memory of their parents Mr. and Mrs. L.H.M Lui.

Supplementary material

345_2018_2407_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Thomas Ahlering
    • 1
    Email author
  • Linda My Huynh
    • 1
  • Kamaljot S. Kaler
    • 1
  • Stephen Williams
    • 2
  • Kathryn Osann
    • 3
  • Jean Joseph
    • 4
  • David Lee
    • 5
  • John W. Davis
    • 6
  • Ronney Abaza
    • 7
  • Jihad Kaouk
    • 8
  • Vipul Patel
    • 9
  • Isaac Yi Kim
    • 10
  • James Porter
    • 11
  • Jim C. Hu
    • 12
  1. 1.Department of UrologyUniversity of California, Irvine HealthOrangeUSA
  2. 2.Division of Urology, Department of SurgeryUniversity of Texas Medical Branch at GalvestonGalvestonUSA
  3. 3.Division of Hematology-Oncology, Department of MedicineUniversity of California, IrvineIrvineUSA
  4. 4.Department of UrologyUniversity of RochesterRochesterUSA
  5. 5.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.UT MD Anderson Cancer CenterHoustonUSA
  7. 7.Department of UrologyOhio Health Robotic Urologic SurgeonsDublinUSA
  8. 8.Department of UrologyCleveland ClinicClevelandUSA
  9. 9.Department of UrologyFlorida Celebration HealthKissimmeeUSA
  10. 10.Department of UrologyRutgers Cancer Center of New JerseyNew BrunswickUSA
  11. 11.Department of UrologySwedish Medical CenterSeattleUSA
  12. 12.Weill Cornell MedicineNew YorkUSA

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