SIU 2017: Impact of Canadian Task Force on Preventative Health Care Recommendation Against PSA Screening on Radical Prostatectomy Results

Lisbon, Portugal ( Following a similar recommendation by its American counterpart, the Canadian Task Force on the Preventative Health Care (CTFPHC) produced a guideline recommending against standard screening for prostate cancer (PCa) with prostate-specific antigen (PSA) in 2014. Like in the US, there has been concern among Canadian urologists that decreased PSA use in primary care might result in diagnosis of higher risk disease and adverse outcomes. 

The authors of this study aimed to determine if there were fewer radical prostatectomies (RPs) performed at their center, and if there had been a clinical and pathological upward stage migration since this recommendation. Data on all men undergoing RP by a single surgeon at a large Canadian center were collected between 2012 and 2015. 

The results demonstrated that in the 344 prostatectomies performed between 2012 and 2015, D'Amico risk group, Gleason scores, pT3 rates, and mean tumour volume were all significantly increased. Additionally, there was a trend toward a higher rate of positive lymph nodes. However, there were no statistically significant changes in age, PSA values, prostatic volume, seminal invasion rates, or positive surgical margins rates. 

The authors therefore conclude, that between 2012 and 2015, there was a significant upward stage migration in prostate cancer treated by RP. The 2012 USPSTF and 2014 CPSTF recommendations might have resulted in referral of fewer screen-detected patients, and fewer patients with low risk disease. Part of the change may be related to greater uptake of active surveillance among low risk patients, as well as an increasing tendency to operate on higher risk patients, as part of multi-modal treatment.

Presented by: Dewar M
Affiliation: Div. of Urology, Western University and London Health Sciences Centre, London, Canada

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal

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