ASCO 2017: History of PSA Screening on Prostate Cancer Aggressiveness

Chicago, IL ( In 2012, PSA screening for prostate cancer (PCa) detection was given a “Grade D” recommendation for all men by the US preventative service task force (USPSTF). Recent U.S. studies report declines in PSA screening with concomitant increases in advanced PCa at diagnosis. Dr. Gerald presented a study examining the association between PSA screening history and PCa aggressiveness in a racially diverse, military cohort with equal health care access. 

This retrospective cohort study evaluated PCa patients undergoing radical prostatectomy (RP) from 1994-2015 at Walter Reed National Military Medical Center. Whole-mounted prostatectomy specimens were classified using 2014 ISUP Gleason grading system. Excluding the diagnostic PSA, screening history was categorized as: ≥ 6 PSA’s prior to PCa diagnosis (uppermost quartile), 1-5 (lower 3 quartiles), vs. no screening history. Multivariable logistic regression (MLR) was used to examine NCCN risk stratum (intermediate-high vs. low) and Gleason upgrade from biopsy to RP. Multivariable models controlled for age at RP, race, family history and obesity (BMI > 30 vs. ≤ 30 kg/m2). 

There were 1,772 eligible patients with a median follow-up and age at RP of 7.0 and 59.8 years, respectively. Prior to PCa diagnosis, 42% and 19% of men had 1-5 and ≥ 6 PSA’s screenings, respectively. MLR showed greater odds of intermediate or high vs. low risk disease for PSA screening history of none vs. 1-5 (OR = 1.33, CI = 1.03-1.70, p = 0.028) but not for none vs. ≥ 6 (p = 0.44). MLR showed increased odds of Gleason upgrade for none vs. ≥ 6 (OR = 1.81, CI = 1.23-2.7, p < 0.001). Multivariable Cox PH models showed incrementally poorer BCR-free survival as screening history decreased (HR None vs. ≥6 = 2.27, CI = 1.54-3.33, p < 0.001; HR None vs. 1-5= 1.49, CI = 1.15-1.92, p = 0.002). 

In summary, higher risk stratum, increased Gleason upgrade, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.

Presented By: Thomas Gerald, MD, Walter Reed National Military Medical Center, Bethesda, MD

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Twitter: @GoldbergHanan

at the 2017 ASCO Annual Meeting - June 2 - 6, 2017 - Chicago, Illinois, USA