To determine whether the characteristics of patients undergoing prostate needle biopsies (PNBs) and PNB results have changed following the U.S. Preventive Services Task Force (USPSTF) recommendation in 2012 against prostate-specific antigen (PSA)-based screening for prostate cancer (PCa) for men of any age.
A prospective database of patients undergoing PNB at Virginia Mason from 2004 to 2014 was reviewed Welch's t-test and Chi-square tests were used to compare patients seen prior to those seen after the USPSTF recommendation. Relative risks and corresponding confidence intervals (CI) were estimated by general linear regression.
Post-USPSTF patients (n=310) had higher PSA levels (p<0.001), were more likely to be diagnosed with higher clinical stage (2b, p=0.003; 2c-3a. p=0.027), and D'Amico high-risk PCa (p=0.036), with an adjusted relative risk (RR) for high-risk PCa of 1.25 (95% CI: 1.02-1.52) compared to pre-USPSTF patients (n=1,416). Limiting the pre-USPSTF group to the 30 months prior to the draft guidelines (n=448) yielded similar results. The absolute number of biopsies performed decreased by 31%, with the majority of the decrease occurring in the detection of intermediate-risk tumors.
In the two and a half years following the USPSTF recommendation against PSA-based screening, patients undergoing PNB were significantly more likely to be diagnosed with high-risk disease. However, reduction in the number of PNBs performed occurred concomitantly with a decrease in detection of intermediate-risk, potentially curable PCa. Future focus on informed application of screening techniques may prevent reversal of decades of improvement in prostate cancer mortality rate.
The Journal of Urology 2015 Aug 05 [Epub ahead of print]
John S Banerji, Erika M Wolff, John D Massman, Katherine Odem-Davis, Christopher R Porter, John M Corman
Virginia Mason, Section of Urology, Seattle, WA , Virginia Mason, Section of Urology, Seattle, WA , Virginia Mason, Section of Urology, Seattle, WA , Center for Biomedical Statistics, University of Washington, Seattle, WA , Virginia Mason, Section of Urology, Seattle, WA , Virginia Mason, Section of Urology, Seattle, WA