From the Journals

Advanced prostate cancers still rising in U.S.


The incidence of advanced prostate cancers in the United States “persistently” increased annually for 5 years after the United States Preventive Services Task Force (USPSTF) controversially advised in 2012 against prostate-specific antigen (PSA) screening in men of all ages, new research indicates.

But a biostatistician not involved with the study said the USPSTF’s recommendation is not wholly to blame because “you need 5 to 7 years of lag time at a minimum to influence PSA screening,” and suggested that other factors were at play.

In the new study, Ahmedin Jemal, DVM, PhD, of the American Cancer Society, and colleagues report that for the period 2012­–2016 there were yearly statistically significant upticks in the incidence of regional-stage disease (by an absolute 11% per year) and in distant-stage disease (by an absolute 5% per year).

At the same time, there were annual drops in the incidence of localized prostate cancers in men 50 years or older.

The new study is the first to report data out to the end of 2016.

The two trends — the increase in advanced cancers and decrease in early-stage cancers — have been occurring for 10 years, more or less, but with a steady, sharp rise in advanced disease starting in 2010 to 2012, the findings show.

“These data illustrate the trade-off between higher screening rates and more early-stage disease diagnoses (possibly overdiagnosis and overtreatment) and lower screening rates and more late-stage (possibly fatal) disease,” the authors comment.

The study was published online May 20 in the Journal of the National Cancer Institute.

Several previous studies have reported incidence pattern changes following the USPSTF recommendations against PSA screening for men aged 75 or older in 2008 and all men in 2012, but the data went no further than 2015.

“We saw hints of these changes in the past few years and now we have further confirmation,” said Ahmad Shabsigh, MD, urologic oncologist at the Ohio State University Comprehensive Cancer Center, who was asked for independent comment.

“What is a surprise is that it’s every year,” Shabsigh told Medscape Medical News, referring to the advanced cancer incidence increases.

“To see it so clearly in this study is sad,” Shabsigh added.

The study period started in 2005, but did not cover the years after 2018, when USPSTF recommendations changed again and advised that screening be “individualized” for men 55 to 69, and that men 70 and over should be excluded.

US cancer registry data, which are the source of the current study, are not yet available to assess the impact of this most recent change.

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