Unintended consequences of decreased PSA-based prostate cancer screening

Thomas Ahlering, Linda My Huynh, Kamaljot S. Kaler, Stephen Williams, Kathryn Osann, Jean Joseph, David Lee, John W. Davis, Ronney Abaza, Jihad Kaouk, Vipul Patel, Isaac Yi Kim, James Porter, Jim C. Hu

    Research output: Contribution to journalArticle

    2 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)1-8
    Number of pages8
    JournalWorld Journal of Urology
    DOIs
    StateAccepted/In press - Jul 12 2018

    Fingerprint

    Early Detection of Cancer
    Prostatic Neoplasms
    Propensity Score
    Neoplasms
    Referral and Consultation
    Lymph Nodes
    Seminal Vesicles
    Advisory Committees
    Prostatectomy
    Odds Ratio
    Recurrence
    Mortality

    Keywords

    • High risk
    • Prostate cancer
    • Screening
    • USPSTF recommendation

    ASJC Scopus subject areas

    • Urology

    Cite this

    Ahlering, T., Huynh, L. M., Kaler, K. S., Williams, S., Osann, K., Joseph, J., ... Hu, J. C. (Accepted/In press). Unintended consequences of decreased PSA-based prostate cancer screening. World Journal of Urology, 1-8. https://doi.org/10.1007/s00345-018-2407-3

    Unintended consequences of decreased PSA-based prostate cancer screening. / Ahlering, Thomas; Huynh, Linda My; Kaler, Kamaljot S.; Williams, Stephen; Osann, Kathryn; Joseph, Jean; Lee, David; Davis, John W.; Abaza, Ronney; Kaouk, Jihad; Patel, Vipul; Kim, Isaac Yi; Porter, James; Hu, Jim C.

    In: World Journal of Urology, 12.07.2018, p. 1-8.

    Research output: Contribution to journalArticle

    Ahlering, T, Huynh, LM, Kaler, KS, Williams, S, Osann, K, Joseph, J, Lee, D, Davis, JW, Abaza, R, Kaouk, J, Patel, V, Kim, IY, Porter, J & Hu, JC 2018, 'Unintended consequences of decreased PSA-based prostate cancer screening', World Journal of Urology, pp. 1-8. https://doi.org/10.1007/s00345-018-2407-3
    Ahlering, Thomas ; Huynh, Linda My ; Kaler, Kamaljot S. ; Williams, Stephen ; Osann, Kathryn ; Joseph, Jean ; Lee, David ; Davis, John W. ; Abaza, Ronney ; Kaouk, Jihad ; Patel, Vipul ; Kim, Isaac Yi ; Porter, James ; Hu, Jim C. / Unintended consequences of decreased PSA-based prostate cancer screening. In: World Journal of Urology. 2018 ; pp. 1-8.
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    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.",
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    AU - Ahlering, Thomas

    AU - Huynh, Linda My

    AU - Kaler, Kamaljot S.

    AU - Williams, Stephen

    AU - Osann, Kathryn

    AU - Joseph, Jean

    AU - Lee, David

    AU - Davis, John W.

    AU - Abaza, Ronney

    AU - Kaouk, Jihad

    AU - Patel, Vipul

    AU - Kim, Isaac Yi

    AU - Porter, James

    AU - Hu, Jim C.

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    N2 - 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.

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