ASCO GU 2022: Impact of U.S. Preventative Services Task Force Grade D Recommendation Against PSA Screening on Prostate Cancer Mortality

( The 2022 GU ASCO Annual meeting included a prostate cancer session highlighting work from Dr. Laura Burgess and colleagues presenting results of their study assessing the impact of the U.S. Preventative Services Task Force (USPSTF) grade D recommendation against PSA screening on prostate cancer mortality. The USPSTF recommendation regarding PSA transitioned to a grade D recommendation against PSA screening for adult males in 2012. The impact of this recommendation against PSA screening on prostate cancer-specific mortality (PCSM) in contemporary cohorts is unknown. This study evaluated PCSM between 1999-2019, comparing mortality rates before and after this change to screening guidelines.

Age-adjusted PCSM rates per 100,000 men were obtained from the National Center for Health Statistics from 1999 – 2019. Trends in PCSM rates from 1999 – 2012 and 2014 – 2019 were estimated using linear regression with year and binary indicator of pre-2013/post-2013 status as interaction terms. Age-adjusted rates of PCSM were calculated for men ≥50 years and by race, ethnicity, urbanization, and census region. Similarly, age-adjusted rates of overall cancer mortality (exclusive of PCSM) were calculated. Behavioral Risk Factor Surveillance System was used to establish trends in PSA screening from 2001 – 2018. North American Association of Central Cancer Registries was used to determine the age-adjusted incidence of localized and metastatic PC at the time of diagnosis from 1999 – 2017.

The age-adjusted PCSM rate in the U.S. decreased linearly at a rate of (-)0.28 per 100,000/year from 1999 – 2012 and subsequently stalled at a rate of no change from 2014 – 2019 (p < 0.001). This effect was particularly striking for men aged 60 – 69, men > 80 years, and Black men. Men aged 60 – 64 had a decreasing rate of (-)0.009 per 100,000/year prior to 2013, followed by a rise of (+)0.001 per 100,000/year (p < 0.001). Among Black men, PCSM rate was decreasing linearly at (-)0.700/100,000/year from 1999-2012 and flattened at a rate of (-)0.091/100,000/year from 2014-2019 (p < 0.001):

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These changes were seen across races, urbanization, and census regions (p < 0.001) and were accompanied by decreases in PSA screening (p = 0.02) together with increases in the diagnosis of metastatic disease. These trends were inconsistent with mortality trends observed across all malignancies:

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Dr. Burgess concluded her presentation assessing the impact of the USPSTF grade D recommendation against PSA screening on prostate cancer mortality with the following take-home messages:

  • Using comprehensive data on PCSM through 2019, this study illustrates decreasing PCSM over time which flattened or increased following the 2012 change in USPSTF guideline, along with a decrease in PSA screening
  • The change in PCSM was seen in all ages, races, ethnicities, urbanization, and census regions, but particularly in men from 60 – 69 and > 80 years old, and Black men
  • These changes were accompanied by increased diagnosis of metastatic prostate cancer and are discordant from trends across other malignancies
  • These findings suggest that the change in PSA screening guidelines may have contributed to the stagnancy of PCSM rates in recent years
  • The updated 2018 USPSTF guideline supporting shared-decision making may reverse these trends over time

Presented by: Laura Burgess, MD, MSc, Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada

Co-Authors: Christopher M. Aldrighetti, Anushka Ghosh, Andrzej Niemierko, Fumiko Chino, Melissa Jessica Huynh, Jason A. Efstathiou, Sophia C. Kamran 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Thursday Feb 17 – Saturday Feb 19, 2022