Implications of the United States Preventive Services Task Force Recommendations on Prostate Cancer Stage Migration

The increase in incidence of metastatic prostate cancer from 2008 to 2012 correlates with each United States Preventive Services Task Force recommendation change. De-escalation of screening guidelines for prostate cancer may lead to delayed diagnosis of clinically significant prostate cancer and to an increased number of men diagnosed with metastatic disease. Background: Prostate-specific antigen screening is controversial. In 2008, the United States Preventive Services Task Force recommended against screening men aged > 75 years, and in 2012, expanded this to include all men. The impact of these changes continues to unfold. We hypothesized that these screening changes could delay the diagnosis of advanced prostate cancer. Materials and Methods: The Surveillance, Epidemiology, and End Results database was used to identify men (age, 55-69 years) diagnosed with prostate cancer in 2004 to 2008 (group 1), 2009 to 2012 (group 2), and 2013 to 2015 (group 3). Groups reflect United States Preventive Services Task Force guideline changes. Descriptive statistics were used to present baseline statistics and the number of patients diagnosed in aforementioned groups. Data was adjusted for population growth. Results: A total of 328,586 men were identified (group 1, 135,625; group 2, 117,979; group 3, 74,982). The average number of men diagnosed annually with N1M0 (group 1, 381; group 2, 477; group 3, 660) and M1 (group 1, 523; group 2, 761; group 3, 1037) disease increased. With group 1 as control, there was a decrease in the incidence of localized disease (group 2, 9.2%; group 3, 33.2%). However, the incidence of N1M0 (group 2, 5.3%; group 3, 30.1%) and M1 disease (group 2, 22.6%; group 3, 49.2%) increased. Separate analyses of patients (age 50-75 years) and African Americans showed similar trends. Conclusion: With each recommendation, there was increased incidence of de novo metastatic prostate cancer. The sequelae of advanced disease include financial, emotional, and physical burden. Future studies are needed to identify screening strategies that reduce the risk of developing metastatic disease without over-diagnosing indolent cancers.

Automated summary

The study found that the increase in incidence of metastatic prostate cancer from 2008 to 2012 is correlated with changes in the recommendations of the United States Preventive Services Task Force, potentially leading to delayed diagnosis of clinically significant prostate cancer and an increased number of men diagnosed with metastatic disease.