Thomas Ahlering1, Linda My Huynh2, Kamaljot S Kaler2, Stephen Williams3, Kathryn Osann4, Jean Joseph5, David Lee6, John W Davis7, Ronney Abaza8, Jihad Kaouk9, Vipul Patel10, Isaac Yi Kim11, James Porter12, Jim C Hu13. 1. Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA. tahlerin@uci.edu. 2. Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA. 3. Division of Urology, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA. 4. Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, USA. 5. Department of Urology, University of Rochester, Rochester, NY, USA. 6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 7. UT MD Anderson Cancer Center, Houston, TX, USA. 8. Department of Urology, Ohio Health Robotic Urologic Surgeons, Dublin, OH, USA. 9. Department of Urology, Cleveland Clinic, Cleveland, OH, USA. 10. Department of Urology, Florida Celebration Health, Kissimmee, FL, USA. 11. Department of Urology, Rutgers Cancer Center of New Jersey, New Brunswick, NJ, USA. 12. Department of Urology, Swedish Medical Center, Seattle, WA, USA. 13. Weill Cornell Medicine, New York, NY, USA.
Abstract
BACKGROUND: In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality. MATERIALS AND METHODS: To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching. RESULTS: Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8 ng/mL) and mean age (60.8-62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement. CONCLUSIONS: All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.
BACKGROUND: In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality. MATERIALS AND METHODS: To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching. RESULTS: Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8 ng/mL) and mean age (60.8-62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement. CONCLUSIONS: All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.
Entities:
Keywords:
High risk; Prostate cancer; Screening; USPSTF recommendation
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