Screening for prostate cancer has been a controversial topic over the past several years, with some disagreement among medical professionals. Men may be understandably uncertain about whether and how to be screened—if they are even aware of the option.
Guidance on PSA screening for prostate cancer has changed over time. In 2008, the United States Preventive Services Task Force (USPSTF) concluded that there was not enough evidence to make an assessment, and in 2012, recommended against routine PSA screening for prostate cancer, citing concerns that the risks of overdiagnosis and overtreatment outweighed the benefits. Since then, diagnoses of distant-stage prostate cancer have increased: from 4% of total cases in 2003 to 8% in 2017—but the cause and effect relationship was not established.
This trend is particularly concerning because metastatic disease is deadly. When diagnosed early, prostate cancer is over 99% treatable, but for men diagnosed with distant-stage prostate cancer, only 30% live 5 years or longer.
Now, a recent study using survey data on millions of men across the country has once again turned the spotlight on this issue, demonstrating a link between decreased PSA screening and increased distant-stage prostate cancer. Vidit Sharma, MD, of Mayo Clinic, and colleagues looked at data from individual states to test whether changes in rates of PSA screening could explain increased rates of metastatic prostate cancer.
The study reported that from 2008 to 2016, the percentage of men screened decreased (from 61.8% to 50.5%), while the incidence of metastatic prostate cancer at diagnosis increased (from 6.4 to 9.0 cases per 100,000). Furthermore, states with larger drops in PSA screening had larger increases in distant-stage prostate cancer. Based on a statistical model, the researchers concluded that the connection was not simply due to chance.
In 2018, the USPSTF recommended that the decision about PSA screening for men aged 55-69 be an individual one, in concert with their physician. However, it is too early to be able to measure the effect of this most recent change on rates of advanced prostate cancer.
At PCF, our position is that prostate cancer screening, when conducted properly, reduces morbidity and mortality. Yet to avoid overdiagnosis and overtreatment of indolent disease, it is vital to transform screening with new research that PCF is propelling that makes it targeted and personalized for each patient in front of the doctor.
PCF encourages men to start talking with their doctors about prostate cancer screening at age 45, or age 40 if they have certain risk factors (Black race or a strong family history of prostate or other cancers). To help start the conversation, go to pcf.org/guides to download Things Every Man Should Know About Prostate Cancer.