The study, conducted jointly at the Center for Surgery and the Public Health at Brigham and Women’s Hospital (BWH) in Boston and Henry Ford Health System’s Vattikuti Urology Institute in Detroit, looked at PSA screening data before and after a 2012 recommendation by the US Preventive Services Task Force (USPSTF).
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Penson’s calculation of 1,241 additional prostate cancer deaths from a single year’s decline in PSA screenings is based on a 2014 study in eight European countries.
In one study, researchers with the American Cancer Society (ACS) found that in 2013, 31 percent of USA men age 50 and older said they’d had a PSA test in the past year.
Others feared the new recommendation would cause more men to die from prostate cancer because their tumors would not be found until the cancer had progressed.
Today, there are less American men diagnosed with prostate cancer in the United States.
He said it would be better to “screen smarter” by testing most men less often and focusing more on those at high risk.
In an editorial that accompanies the studies, David F. Penson of Vanderbilt University’s Department of Urologic Surgery suggests that “there is reason to be concerned” about both the drop in screenings and the decline in cancer diagnoses.
But the task force concluded the testing caused unnecessary suffering and that there was insufficient evidence that annual PSA screening significantly reduced the death rate from prostate cancer. The number of men 50 years and older diagnosed with prostate cancer nationwide declined by 33,519, from 213,562 in 2011 to 180,043 in 2012.
A few doctors welcomed the change by the influential panel of experts, saying it would save many men from experiencing false alarms and potentially serious complications of unnecessary treatment.
In 2015, more than 220,000 men are expected to be diagnosed with prostate cancer and more than 27,000 to die from it, according to the American Cancer Society.
Results Prostate cancer incidence per 100 000 in men 50 years and older (N=446 009 in SEER areas) was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012; rates began decreasing in 2008 and the largest decrease occurred between 2011 and 2012, from 498.3 (99% CI, 492.8-503.9) to 416.2 (99% CI, 411.2-421.2). The PSA screening rate was determined for men 50 years and older without a history of prostate cancer who responded to the 2005 (n = 4,580), 2008 (n = 3,476), 2010 (n = 4,157), and 2013 (n = 6,172) National Health Interview Survey. In relative terms, screening rates increased by 10% (SRR, 1.10; 99% CI, 1.01-1.21) between 2005 and 2008 and then decreased by 18% (SRR, 0.82; 99% CI, 0.75-0.89) between 2010 and 2013.
That group also says screening every other year should be an option, and advises against screening for men over 70 or those with a less than 10-to-15 year life expectancy.
Others, however, were more anxious about the trends in the ACS report.
Prostate cancer often grows slowly.
Active surveillance means that a man’s cancer is monitored over time, using PSA tests and possibly biopsies of the tumor. “As we move from traditional fee-for-service reimbursement models to accountable care organizations and bundled payments to curb growing health care expenditures, understanding the true costs of health care is essential”, said first author Aaron Laviana, MD, of UCLA, in a press release from that institution. “However, we found a decrease in the prevalence of PSA screening following the 2012 recommendations, particularly in men younger than 75 years”, the authors write.
“I do hope physicians are talking to their patients and letting the patient decide whether or not to be screened”, Brawley said.
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“I think it’s a good thing if doctors and men are having a discussion so that the patient can truly make an informed decision”, says the American Cancer Society’s Brawley.
