Less Prostate Cancer Screening May Delay Treatment for Earlier Onset Cancers

More Advanced Cancers Are Being Found in Fewer Needle Biopsies, Say Investigators in The Journal of Urology®

New York, NY, January 6, 2016

The U.S. Preventive Services Task Force (USPSTF) recommendation against regular prostate specific antigen (PSA) screening for prostate cancer (PCa) has been in place for two and a half years. Although the number of prostate needle biopsies (PNB) has been reduced, patients who undergo PNB are significantly more likely to be diagnosed with high risk disease, and detection of intermediate risk, potentially curable PCa, has likely decreased. While “over diagnosis” and “overtreatment” may have been impacted, there is concern that diagnosis of treatable cancers will be delayed, according to investigators reporting in The Journal of Urology®.

PCa remains the second leading cause of cancer death among men in the U.S., with nearly 30,000 deaths annually. Deaths from PCa have declined by about 40% since the advent of PSA screening in the late 1980s, and 40-70% of that decline may be attributable to screening. However, radiation therapy and surgery have negative impacts on quality of life. The uncertain benefit of PSA-based screening, combined with the complications associated with treatment, led the USPSTF to conclude in October 2011 that the harms of PSA-based screening outweighed the benefits, leading to their recommendation against regular screening.

“Results from our study support the argument that declining PSA screening may result in delayed diagnosis, potentially leading to avoidable cancer deaths,” according to John M. Corman, MD, Virginia Mason, Seattle, WA. “When compared to patients who underwent PNB in the 30 months prior to the USPSTF recommendation, those who underwent PNB in the 30 months after had a 33% higher relative risk of being diagnosed with high risk PCa. The reduction in the number of potentially unnecessary biopsies appears to have occurred at the cost of detecting fewer intermediate risk PCa tumors. Thus, the key concern is not only the increased risk of being diagnosed with high risk disease, but, more importantly, the missed opportunity to offer curative intervention for patients with intermediate risk PCa.”

The investigators compared the results of patients who underwent PNB before and after the USPSTF recommendations. The post-USPSTF group had a higher median PSA (p <0.001), was significantly less likely to have a PSA ≤6 ng/ml (p <0.001), and was significantly more likely to have a PSA between 6.1–10 ng/ml (p=0.019) or 10.1–20 ng/ml (p=0.002) than the pre-USPSTF group. Patients were significantly more likely to be diagnosed with clinical stage 2b (p=0.001) or stage 2c-3a PCa (p=0.027). Finally, among those with cancer, patients in the post-USPSTF group were significantly more likely to be diagnosed with D’Amico high risk PCa (p=0.036).

“The importance of our study is not only the evolution in patient and tumor characteristics seen at PNB, but the rapidity by which statistically significant changes occurred following the release of the USPSTF recommendations,” explained Dr. Corman. “The goal of PCa screening is to maximize the benefit of screening tools such as PSA while minimizing the harm associated with over diagnosis and overtreatment. Rather than relegating PSA into oblivion, the balanced answer may be best found in the more intelligent use of available tools, implementation of shared decision making as recommended by the American Cancer Society, and development of more effective screening techniques.”

---

Notes for Editors
“Prostate Needle Biopsy Outcomes in the Era of the U.S. Preventive Services Task Force Recommendation Against PSA-Based Screening,” by John S. Banerji, Erika M. Wolff, John D. Massman III, Katherine Odem-Davis, Christopher R. Porter, and John M. Corman, DOI:  http://dx.doi.org/10.1016/j.juro.2015.07.099,  The Journal of Urology®, Volume 195, Issue 1 (January 2016), published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Eileen Leahy at +1 732 238 3628 or jumedia@elsevier.com to obtain copies. Journalists wishing to interview the authors should contact John M. Corman, MD, at +1 206 625 7373 x 63348 or John.Corman@virginiamason.org.

About The Journal of Urology® 
Established in 1917, The Journal of Urology® is the official journal of the American Urological Association. It is the most widely read and highly cited journal in the field. It brings to its readership all the clinically relevant information needed to stay at the forefront of this dynamic field. This top-ranking journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide and practice-oriented reports on interesting clinical observations.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media contact
Eileen Leahy
Elsevier
+1 732 238 3628
jumedia@elsevier.com