The effect of the United States Preventive Services Task Force grade D recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the US.

In October 2011, the United States Preventive Services Task Force (USPSTF) issued a draft guideline, discouraging the use of prostate-specific antigen (PSA) based screening for prostate cancer (grade D recommendation).

Our objective was to evaluate the effect of the USPSTF guideline on the number and distribution of new prostate cancer diagnoses in the US.

We identified incident cancers diagnosed between January 2010 and December 2012 in the National Cancer Database. We performed an interrupted time series to evaluate the trend of new prostate cancers diagnosed each month before and after the draft guideline, with colon cancer as a comparator.

Incident monthly prostate cancer diagnoses dropped by -1363 cases (12.2%, p<0.01) in the month after the USPSTF draft guideline and continued to decrease by 164 cases per month relative to baseline (-1.8%; p<0.01). By contrast, monthly colon cancer diagnoses remained stable. Diagnoses of low, intermediate, and high-risk prostate cancers decreased significantly, but new diagnoses of non-localized disease did not change. Subgroups of age, comorbidity, race, income, and insurance all experienced comparable decreases in incident prostate cancer following the draft guideline.

There was a 28% decline in incident diagnoses of prostate cancer in the year following the USPSTF draft recommendation against PSA screening. This study helps quantify the potential benefits (reduced harms of overdiagnosis and overtreatment of low risk disease and disease found in elderly men) and potential harms (missed opportunities to diagnose important cancers in men who may benefit from treatment) of this guideline.

The Journal of urology. 2015 Jun 15 [Epub ahead of print]

Daniel A Barocas, Katherine Mallin, Amy J Graves, David F Penson, Bryan Palis, David P Winchester, Sam S Chang

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN. Electronic address: dan. barocas@vanderbilt. edu. , National Cancer Data Base, American College of Surgeons, Chicago, IL. , Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN. , Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN. , National Cancer Data Base, American College of Surgeons, Chicago, IL. , National Cancer Data Base, American College of Surgeons, Chicago, IL. , Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.

PubMed