Advertisement

Changes in Prostate Cancer Presentation Following the 2012 USPSTF Screening Statement: Observational Study in a Multispecialty Group Practice

Abstract

Background

In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer in men of all ages. Following this change, screening declined yet the complete impact on clinical presentation is not well defined in the screen-eligible population.

Objective

To determine if the rates of PSA screening, prostate biopsy, incident prostate cancer detection, and stage IV at presentation in screen-eligible men in Kaiser Permanente Northern California changed following the 2012 USPSTF Prostate Cancer Screening recommendations.

Design

Retrospective study spanning the years 2010 to 2015, in screen-eligible Kaiser Permanente Northern California members (African American men ages 45–69 and all other men ages 50–69) with no prior history of prostate cancer.

Participants

All screen-eligible, male members during 2010 (n = 403,931) to 2015 (n = 483,286) without a history of prostate cancer within all Kaiser Permanente Northern California facilities.

Main Measures

Annual rates of PSA testing, prostate biopsy, incident prostate cancer detection, and stage IV cancer at presentation were compared between the pre-guideline period, 2010 and 2011, and the post-guideline period, 2014 and 2015, in men under the age of 70.

Key Results

Following the 2012 USPSTF guideline change, screening rates declined 23.4% (95% CI 23.0–23.8%), biopsy rates declined 64.3% (95% CI 62.9–65.6%), and incident prostate cancer detection rates declined 53.5% (95% CI 50.1–56.7%) resulting in 1871 fewer incident cancers detected, and metastatic cancer rates increased 36.9% (95% CI 9.5–71.0%) resulting in 75 more stage IV cancers detected.

Conclusion

Less screening resulted in a large decrease in cancer detection, some of which may be beneficial as many cancers may be indolent, yet this decrease occurred at the expense of an increase in metastatic cancer rates. For every 25 fewer cancers detected, one metastatic cancer was diagnosed. This information may be valuable in the shared decision-making process around prostate cancer screening.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1

References

  1. 1.

    American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society; 2018.

  2. 2.

    Schröder FH, Hugosson J, Roobol MJ, et al; ERSPC Investigators. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014; 384(9959): 2027–2035.

  3. 3.

    Pinsky P, Prorok P, Yu K, et al. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer 2017; 123(4): 592–599.

  4. 4.

    Moyer VA; US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157(2):120–134.

  5. 5.

    Tasian GE, Cooperberg MR, Cowan JE, et al: Prostate specific antigen screening for prostate cancer: knowledge of attitudes towards, and utilization among primary care physicians. Urol Oncol 2012; 30(2): 155–160.

  6. 6.

    Grossman DC, US Preventive Services Task Force: Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA 2018; 319(18): 1901–1913.

  7. 7.

    Jemal A, Fedewa SA, Ma J, et al: Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 2015; 314(19): 2054–2061.

  8. 8.

    Li J, Berkowitz Z and Hall IJ: Decrease in prostate cancer testing following the US Preventive Services Task Force (USPSTF) recommendations. J Am Board Fam Med 2015; 28(4): 491–493.

  9. 9.

    Sammon JD, Abdollah F, Choueiri TK, et al: Prostate-specific antigen screening after 2012 US Preventive Services Task Force recommendations. JAMA 2015; 314(19): 2077–2079.

  10. 10.

    Drazer MW, Huo D and Eggener SE: National prostate cancer screening rates after the 2012 US Preventive Services Task Force recommendations. J Clin Oncol 2015; 33(22): 2416–2423.

  11. 11.

    Kim SP, Kanes RJ, Gross CP, et al: Contemporary national trends of prostate cancer screening among privately insured men in the United States. Urology 2016; 97: 111–117.

  12. 12.

    Gershman B, Van Houten HK, Herrin J, et al: Impact of prostate-specific antigen (PSA) screening trials, and revised PSA screening guidelines on rates of prostate biopsy and postbiopsy complications. Eur Urol 2017; 71(1): 55–65.

  13. 13.

    Banerji JS, Wolff EM, Massman JD III, Odem-Davis K, Porter CR, Corman JM: Prostate needle biopsy outcomes in the era of the US Preventive Services Task Force recommendation against prostate specific antigen based screening. J Urol 2016; 195(1): 66–73.

  14. 14.

    Bhindi B, Mamdani M, Kulkarni GS, et al: Impact of the US Preventive Services Task Force recommendations against prostate specific antigen screening on prostate biopsy and cancer detection rates. J Urol 2015; 193(5): 1519–1524.

  15. 15.

    McGinley KF, McMahon GC and Brown GA: Impact of the US Preventive Services Task Force grade D recommendation: assessment of evaluations for elevated prostate-specific antigen and prostate biopsies in a large urology group practice following statement revision. Rev Urol 2015; 17(3): 171–177.

  16. 16.

    Halpern JA, Shoag JE, Artis AS, et al: National trends in prostate biopsy and radical prostatectomy volumes following the US preventive Services Task Force guidelines against prostate-specific antigen screening. JAMA Surg 2017; 152(2): 192–198.

  17. 17.

    Jemal A, Ma J, Siegel R, Fedewa S, Brawley O, Ward EM: Prostate cancer incidence rates 2 years after the US Preventive Services Task Force recommendations against screening. JAMA Oncol 2016; 2(12): 1657–1660.

  18. 18.

    Reese ACD, Wessel SR, Fisher SG, Mydlo JH: Evidence of prostate cancer “reverse stage migration” toward more advanced disease at diagnosis: data from the Pennsylvania Cancer Registry. Urol Oncol 2016; 34(8): 335.e21–335.e28.

  19. 19.

    Hu JC, Nguyen P, Mao J, et al: Increase in prostate cancer distant metastases at diagnosis in the United States. JAMA Oncol 2017; 3(5): 705–707.

  20. 20.

    Negoita S, Feuer EJ, Mariotto A, et al: Annual report to the nation on the status of cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer 2018; 124(13): 2801–2814.

  21. 21.

    Kelly SP, Anderson WF, Rosenberg PS, Cook MB: Past, current and future incidence rates and burden of metastatic prostate cancer in the United States. Eur Urol Focus 2018; (4): 121–127.

  22. 22.

    Escobar GJ, Gardner M, Greene JG, Draper D, Kipnis P: Risk-adjusting hospital mortality using a comprehensive electronic record in an integrated healthcare delivery system. Med Care 2013; 51: 446–453.

  23. 23.

    Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK eds. AJCC Cancer Staging Manual/Eighth Edition. New York, NY: Springer International Publishing; 2017.

  24. 24.

    Bernal JL, Cummins S, Gasparrini A: Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol 2017; 46(1): 348–355.

  25. 25.

    Harrington D, D’Agostino RB, Gatsonis C, et al: New guidelines for statistical reporting in the Journal. N Engl J Med 2019 381: 285–286.

  26. 26.

    Henry MA, Howard DH, Davies BJ, Filson CP: Variation in use of prostate biopsy following changes in prostate cancer screening guidelines. J Urol 2017; 198(5): 1046–1053.

  27. 27.

    Greenland S, Morgenstern H: Ecological bias, confounding, and effect modification. Int J Epidemiol 1989;18(1): 269–274.

  28. 28.

    Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 2015; 373(8): 737–746.

Download references

Author information

Correspondence to Joseph Presti Jr. MD.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

This study was reviewed and approved by the Kaiser Permanente Northern California Institutional Review Board.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior Presentations

ASCO 2018 Genitourinary Cancers Symposium February 8, 2018.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Presti, J., Alexeeff, S., Horton, B. et al. Changes in Prostate Cancer Presentation Following the 2012 USPSTF Screening Statement: Observational Study in a Multispecialty Group Practice. J GEN INTERN MED (2019) doi:10.1007/s11606-019-05561-y

Download citation

KEY WORDS

  • cancer screening
  • prostate cancer
  • shared decision-making