SOURCE: Jemal A, et al. Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 2015;314:2054-2061.
Prostate cancer screening has been an embattled topic for more than a decade. While intuitively appealing to both the clinician population and mid-life males, outcomes from large clinical trials could not confirm improvements in overall survival subsequent to screening, and, with the exception of one large trial with contentious results, data were similarly unsupportive of even reduced mortality related to prostate cancer itself. Showing how the same data can be perceived differently by different experts, the U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA) screening. The American Cancer Society endorses it in men > 50 years of age with at least a 10-year life expectancy. The American Urologic Association recommends PSA screening in men 55-59 years of age.
In 2008, the USPSTF recommended against PSA screening in men > 75 years of age, after which there was a minimal decline. Did clinicians heed the 2012 USPSTF advice to cease screening in asymptomatic men regardless of age?
Jemal et al reviewed data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) population (n = 446,000) to compare PSA screening rates between 2005 and 2013. They found an 18% decline in prostate cancer screening between 2010-2013, which was independent of age and included both younger men and men > 75 years of age. Modeling methods have been published that suggest we might experience an increase in prostate cancer mortality by omission of universal screening; to date, that has not been the case, but it may require a longer window of observation before reaching definitive conclusions.