The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

Abstract

Guidelines regarding recommendations for PSA screening for early detection of prostate cancer are conflicting. In 2012, the United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men aged ≥75 years in 2008 and for men of all ages in 2012. Understanding temporal trends in rates of screening before and after the 2012 recommendation in terms of usage patterns in PSA screening, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has influenced physician's and men's attitudes about PSA screening and subsequent ordering of other screening tests is essential within the scope of prostate cancer screening policy. Since the 2012 recommendation, rates of PSA screening decreased by 3-10% in all age groups and across most geographical regions of the USA. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a shift towards tumours being of higher grade and stage upon detection. Despite the recommendation, some physicians report ongoing willingness to screen appropriately selected men, and many men report intending to continue to ask for the PSA test from their physician. In the coming years, we expect to have an improved understanding of whether these decreased rates of screening will affect prostate cancer metastasis and mortality.

Figure 1

Age-adjusted prostate cancer incidence rate in the Surveillance, Epidemiology and End Results (SEER 9) database by age at diagnosis from 1975 to 2013 in the USA. Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database. The figure is extracted with permission from the SEER Database. https://seer.cancer.gov/

Figure 2

Age-adjusted prostate cancer incidence rates in the Surveillance, Epidemiology and End Results (SEER) database by age at diagnosis from 1975 to 2013 in the USA. Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database. The figure is extracted with permission from the SEER Database. https://seer.cancer.gov

Figure 3

Age-adjusted prostate cancer incidence rates in the Surveillance, Epidemiology and End Results (SEER 9) database by race/ethnicity, from 1975 to 2013 in the USA. Rates are per 100,000 and age-adjusted to the 2000 US standard population. The figure is extracted with permission from the SEER Database. The figure is extracted with permission from the SEER Database. https://seer.cancer.gov