Less prostate cancer screening reduces overdiagnosis but may miss
aggressive cases
Date:
April 22, 2022
Source:
Weill Cornell Medicine
Summary:
Over the past 15 years, public health authorities have downgraded
recommendations for the prostate-specific antigen (PSA) test as a
screening tool to reduce the overdiagnosis and overtreatment of
men with low-grade prostate cancer. Now, researchers have found
that while these efforts have been effective, the incidence of
higher-grade disease and metastasis at diagnosis have risen.
FULL STORY ==========================================================================
Over the past 15 years, public health authorities have downgraded recommendations for the prostate-specific antigen (PSA) test as a
screening tool to reduce the overdiagnosis and overtreatment of men with low-grade prostate cancer. Now, researchers from Weill Cornell Medicine
have found that while these efforts have been effective, the incidence of higher-grade disease and metastasis at diagnosis have risen. The research
was published March 22 in theJournal of the National Cancer Institute.
==========================================================================
"To our knowledge, this is the first study to demonstrate nationally that
low- grade prostate cancer is no longer the most commonly diagnosed type
of prostate cancer," said senior author Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director
of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill
Cornell Medical Center. "One of the weaknesses of PSA/prostate cancer
screening was that it led to over- detection of indolent cancers that
would not harm men, subjecting them to anxiety and future testing."
In 2012, the U.S. Preventative Services Task Force (USPSTF) recommended
against screening all men with the PSA test, concluding that the benefits
of the test, which measures levels of a protein often overproduced
in prostate cancer cells, did not outweigh the risks. Then in 2018,
the USPSTF issued a revision to include shared decision making for the
PSA test for men aged 55 to 69 years, reflecting emerging evidence of longer-term benefits and widespread adoption of active surveillance
after detection of low-risk disease.
For their study, Dr. Hu and colleagues identified more than 438,000
men with newly diagnosed prostate cancer between 2010 and 2018 using
a nationally representative database. They examined trends in the
incidence of prostate cancer by disease risk using several measures. One measure was the Gleason Grade, a pathology score based on the microscopic appearance of the prostate cells, determined at biopsy and after radical prostatectomy, a procedure in which the entire prostate is surgically
removed. Additional measures were PSA level and presence of metastasis
at diagnosis. They also investigated whether increasing rates of obesity
or the advent of newer diagnostic tools such as pre-biopsy magnetic
resonance imaging (MRI) and biomarkers might explain incidence trends.
The analysis revealed a significant decrease in the incidence of the
lowest- risk prostate cancer, Gleason Grade 1 (GG1), falling from 52 to 26 cases per 100,000 men across all age groups. Further, the proportion of
GG1 found on pathology in men who had a radical prostatectomy decreased
from 32 to 10 percent. However, metastases rates at diagnosis increased
from 3.0 percent to 5.2 percent over the same period. Halting PSA testing appeared to be the primary driver of these trends.
"The fact that only 10 percent of radical prostatectomy specimens
demonstrate low-grade prostate cancer indicates that even when low
grade cancer is diagnosed, it is being treated much less frequently,
said Dr. Hu. "This demonstrates that there has been acceptance of
active surveillance, also known as monitoring with curative intent,
among doctors and patients nationally." "It is encouraging to see that urologists in the United States have moved away from overutilization
of radical therapies for the management of low-risk prostate cancer,"
added first author Dr. Leonardo Borregales.
Public health authorities should consider implementing risk-stratified screening, such as MRI or biomarkers, continuing to minimize overdiagnosis
and avoid biopsy in men with low-risk prostate cancer while addressing
the rising trends of high-grade and metastatic prostate cancer, the
authors concluded.
========================================================================== Story Source: Materials provided by Weill_Cornell_Medicine. Note:
Content may be edited for style and length.
========================================================================== Journal Reference:
1. Leonardo D Borregales, Gina DeMeo, Xiangmei Gu, Emily Cheng, Vanessa
Dudley, Edward M Schaeffer, Himanshu Nagar, Sigrid Carlsson,
Andrew Vickers, Jim C Hu. Grade Migration of Prostate Cancer in
the United States during the last decade. JNCI: Journal of the
National Cancer Institute, 2022; DOI: 10.1093/jnci/djac066 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/04/220422114745.htm
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