Reduced PSA Screening Correlates With Uptick in Metastatic Prostate Cancer Presentation at Diagnosis

A reduction in prostate-specific antigen (PSA) screening might have a role in the recent increase in metastatic prostate cancer diagnoses in the United States, according to study data presented at the 2021 Genitourinary Cancers Symposium.¹

In both 2008 and 2012, the US Preventive Services Task Force (USPSTF) did not recommend PSA screening due to its correlation with over-treatment, which can have “significant” quality of life implications, according to lead study author, Vidit Sharma, MD, of the University of California, Los Angeles. To date, it has not been known whether reductions in PSA screening contributed to the increase in metastatic prostate cancer diagnoses in the US.

To examine this possibility, Sharma et al obtained age-adjusted incidence rates of metastatic prostate cancer at diagnosis per 100,000 men from the North American Association of Central Cancer Registries from 2002 to 2016 for each state. They extracted survey-weighted PSA screening estimates for each state from the Behavioral Risk Factor Surveillance System.

The findings showed significant variation between states in the percentage of men older than 40 years who reported ever completing PSA screening. Specifically, the rates ranged from 40.1% to 70.3%. Variations were also found in the age-adjusted incidence of metastatic prostate cancer at diagnosis, which ranged from 3.3 to 14.3 per 100,000.

From 2008 to 2016, the mean percentage of men screened for PSA decreased from 61.8% to 50.5%. By contrast, the mean incidence of metastatic prostate cancer at diagnosis increased from 6.4 to 9.0 per 100,000 (Bonferroni-adjusted P < 0.001 for both).

Data from a random-effects linear regression model showed that longitudinal reductions in PSA screening across states were associated with increased metastatic prostate cancer (regression coefficient per 100,000 men: -14.9; 95% CI, 12.3-17.5; P <.01). According to the researchers, this indicates that the states with larger decreases in PSA screening had larger increases in metastatic prostate cancer at diagnosis.

“We support shared-decision making policies that may optimize PSA screening utilization to reduce the incidence of metastatic prostate cancer in the United States,” Sharma said.

Disclosures: Some of the study authors disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the original study. The research was supported by a VA Health Services Research & Development Fellowship.