Increase in higher risk prostate cancer cases following new screening recommendation by the US Preventive Services Task Force (USPSTF).

Abstract

143 Background: In 2011, the USPSTF issued a draft recommendation that PSA not be used for prostate cancer screening in men irrespective of age. Here we present early measures of the potential consequences of this recommendation. Methods: Data on men diagnosed with prostate cancer from January, 2005 through June, 2013 were extracted from the National Oncology Data Alliance (Elekta/IMPAC Medical Systems, Inc., Sunnyvale, CA). This proprietary database of merged tumor registries captures newly diagnosed cancer cases at more than 150 hospitals in the United States. Data were available through 2013 compared to 2011 in Surveillance, Epidemiology, and End Results (SEER). The data in the NODA are identical to the data sent to state tumor registries and SEER in regions that participate in SEER. Date of diagnosis, age, race, T stage, Gleason score, and PSA were collected. Patients were classified into their respective National Comprehensive Cancer Network (NCCN) risk group. Data were available and analyzed for 87,562 men. Frequencies were examined by date of diagnosis, grouped in six-month intervals. Trends were assessed using linear regression. Results: From 2005 to 2011, the percentage of men with PSA>10 decreased gradually. From 2011 to 2013, the percentage increased by 3.0% per year (p<0.0004). The fraction of men with age ≥75 years to present with PSA>10 increased by nearly double the rate for men of all ages from 2011 to 2013. No significant trends in Gleason score were observed; the frequency of men with higher T stages generally decreased over the entire period without a notable change after 2011. The percentage of men with intermediate or higher risk cancer was stable at 70-73% prior to 2011, but rose by 2.9 % per year after 2011 (p<0.003) without evidence of a plateau. Conclusions: The proportion of men diagnosed with intermediate or higher risk cancer increased by nearly 6% from 2011 to 2013. Given an estimated 233,000 new prostate cancers in 2014, approximately 14,000 men per year will shift from low risk into a higher risk disease group. Our findings suggest an increase in the fraction of men diagnosed with higher risk prostate cancer after 2011.