Weill Cornell Medicine Urology
Weill Cornell Medicine Urology
Incidence of metastatic prostate cancer has increased among older men as PSA screening declines (With Dr. Jim C. Hu)

Incidence of metastatic prostate cancer has increased among older men as PSA screening declines (With Dr. Jim C. Hu)

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The incidence of metastatic prostate cancer appears to be rising in men aged 75 years or older, according to results of a SEER analysis published in JAMA Oncology.

This increase may be linked to the U.S. Preventive Services Task Force (USPSTF) 2008 recommendation against routine PSA screenings in men aged 75 years or older and the 2012 recommendation against routine PSA screening regardless of age.

"It's what most of us would have predicted, although somewhat sooner," Jim C. Hu, MD, MPH, professor of urologic oncology at Weill Cornell Medicine, said in a press release. "There was a decrease in prostate cancer metastasis and death after the advent of PSA testing. Remove the screening, and the rates of serious disease rise again."

Hu and colleagues used the SEER database to identify 1.1 million men aged older than 40 years who were diagnosed with prostate cancer between 2004 and 2013.

Researchers used the Cochrane-Armitage and the Jonckheere-Terpstra test to assess temporal variations in cancer characteristics (available from 2010 to 2013). They used SEER Collaborative staging to analyze quarterly data on incidence of metastasis. Men were stratified based on age younger than or older than 75 years.

The proportion of men aged 75 years or older diagnosed with prostate cancer and distant metastases increased from 6.6% (95% CI, 2.2-7) in 2007 to 12% (95% CI, 11.2-12.7) in 2013. Researchers also observed an increase in the proportion of cancers that were intermediate and high grade, from 58.1% (95% CI, 57.2-59) to 72% (95% CI, 71-73).

During the same period, the incidence of distant metastases increased among men aged younger than 75 years from 2.7% (95% CI, 2.5-2.9) to 4% (95% CI, 3.8-4.2). Intermediate- and high-grade prostate cancer presentation rose from 46.3% (95% CI, 45.9-46.9) to 56.4% (95% CI, 55.9-56.9).

Between 2010 and 2013, median PSA at diagnosis increased among men aged 75 years or older from 9 ng/mL (interquartile range [IQR], 5.8-17.3) to 9.7 ng/mL (IQR, 6.2-21), and among men aged younger than 75 years from 6 ng/mL (IQR, 4.6-9.1) to 6.4 ng/mL (IQR, 4.8-10).

"The recommendation against PSA testing came later for younger men," Hu said. "So, we might need to watch them over time to see the parallel with older men."

Hu added the results underscore to need to reevaluate PSA screening guidelines.

"The public health message is that after years of decline, the incidence of metastatic disease has gone up," he said. "And although the PSA test is not perfect, I don't think people should be told that this test has no value."

Up to 50% of American men diagnosed with prostate cancer now choose active surveillance rather than surgery, Hu said.

"The implication of our study is that it is important to have the right to choose screening in order to know whether a man may have an aggressive or indolent prostate cancer," Hu said. "The burden of overtreatment and side effects may no longer be sufficient to recommend against routine screening."

This text is an exerpt from an article on healio.com: read the full text here.

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