Lower prostate cancer screening rates linked to more advanced cancers

By Nancy Lapid

(Reuters) – A drop in prostate cancer screening has been linked to a subsequent rise in advanced cancers, according to data from the U.S. Department of Veterans Affairs (VA), findings that could prompt a review of current U.S. guidelines for prostate cancer. of testing.

A new study, involving more than 5 million men over the age of 40 at 128 VA facilities across the country between 2005 and 2019, found that when screening was encouraged, subsequent diagnoses of incurable advanced malignancies were less likely .

“Screening rates were significant predictors of metastatic cancer rates,” study leader Dr. Brent Rose of the University of California, San Diego said at a press conference Monday at the American Society for Radiation Oncology (ASTRO) annual meeting in San Antonio. , Texas. Metastatic cancers are those that have progressed and spread to other parts of the body.

The benefits of prostate cancer screening are controversial. In 2012, the US Preventive Services Task Force (USPSTF) advised against it, saying that since the disease is usually very slow progressing, the risks of screening outweigh the potential benefits. There were concerns that suspicion of prostate cancer based on a routine blood test could lead to painful and potentially risky biopsies that might not have been necessary.

In 2018, based on new evidence, the committee changed its recommendation to limit prostate cancer screening to men between the ages of 55 and 69, and only if they “express a preference for screening after being told and understand the benefits and risks”.

Overall, at VA facilities, screening rates with blood tests for prostate-specific antigen (PSA) levels increased from 47.2% in 2005 to 37.0% in 2019, have reported the researchers.

During this period, rates of metastatic prostate cancer increased from 5.2 per 100,000 men to 7.9 per 100,000, with the increase being due to increasing age groups from 55 to 69 years and those over 70, the researchers said.

At individual facilities, higher screening rates were linked to lower rates of subsequent diagnoses of advanced cancers. But for every 10% decrease in screening, there was a corresponding 10% increase in the incidence of metastatic prostate cancer five years later, the researchers said.

Observational studies like this cannot prove cause and effect, and previous randomized trials comparing screening versus no screening have produced conflicting results, further complicating the issue. A large European trial found a significant benefit, but a North American trial did not.

In the North American trial, however, many men assigned to the “surreptitiously” non-screening group were privately screened by their personal physicians, which likely skewed the results, ASTRO’s president-elect said, Dr. Jeff Michalski of the University of Washington School of Medicine. in St. Louis said at the press conference.

Rose noted that while USPSTF advice to limit prostate cancer screening has led to lower rates of prostate cancer diagnoses, rates of metastatic prostate cancer have increased “more dramatically.” “.

“We hope this data will give the USPSTF a chance to re-evaluate its recommendations,” Michalski said.

A USPSTF spokesperson said an update to its prostate cancer screening recommendation is not currently in progress.

(Reporting by Nancy Lapid; Editing by Michele Gershberg and Bill Berkrot)

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