ASCO GU 2018: Impact of 2012 USPSTF Prostate Cancer Screening Recommendations on Prostate Cancer Detection and Presentation at Kaiser Permanente Northern California (KPNC)

San Francisco, CA (UroToday.com) The Kaiser Permanente hospital system, known for its vertical integration in the healthcare system, provides a unique opportunity for clinical research. Similar to a nationalized healthcare system in other countries, as all patient care occurs within the same system, there is the ability for close patient follow-up.

In this study, the authors from the Oakland KP center, a regional center for GU Oncology, present results focusing on the impact of the 2012 USPSTF prostate cancer screening guideline recommendations on PCa detection and presentation. Specifically, the 2012 guidelines gave prostate cancer PSA screening a “D” recommendation, effectively recommended against PSA screening. The most recent 2017 update has reversed course and given it a “C” rating, at least leaving it the physician and patient to undergo shared decision making.

In this retrospective cohort study of screen-eligible (African American men ages 45-69 and all other men ages 50-69) men between the years 2010 to 2015, the authors compared rates of screening and diagnosis pre-guidelines (2010-2011) and post-guidelines (2014-2015). They excluded the 2012-2013 period as a washout period.

They found that the rate of screening declined substantially from the pre-guideline period to the post-guideline period, from a rate of 42.7% per year during 2010/2011 to a rate of 32.5% of per year during 2014/2015; an approximately 34% decline. During the same time frames, the rates of prostate biopsy and overall prostate cancer detection declined even more sharply, with relative rates of 0.391 (95%CI 0.375-0.407) and 0.455 (95%CI 0.436-0.475) respectively. Unfortunately, they don’t specifically comment on the GG of the diagnosed PCa.

More importantly, as other population based studies have begun to demonstrate, there was a modest increase in the rate of metastatic disease at the time of presentation between these two time periods, with a relative rate of 1.29 (95%CI 1.11-1.48). This is the most concerning finding, as PSA screening has effectively reduced the rate of metastatic prostate cancer to record low levels.

Limitations / Discussion Points:
1. There is no details regarding relative proportion of low, intermediate and high-risk cancer. If the only cancers being lost are low-risk disease, this may be acceptable in the larger scheme of things.
2. Having worked in the Kaiser system myself, the KP system has their own institutional guidelines, sometimes independent (though reflective of) national guidelines. Were the USPSTF recommendations taken up by Kaiser as a whole? It is implied that they were, but not made clear.

Speaker: Joe Presti

Co-authors: Brandon Horton, Stacey Alexeeff, Stephanie Prausnitz, Andy Avins

Institution(s): Kaiser Permanente, Oakland, CA

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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