Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and Meta-Analysis

The U.S. Preventive Services Task Force (USPSTF) released a grade D recommendation for prostate-specific antigen (PSA)-based screening in 2012. Since then, there has been a well-documented decrease in the use of both PSA and the digital rectal exam for prostate cancer screening. Population-based studies have suggested that this may be selecting for higher-risk disease. Secondary data studies are limited by clerical error, missing data, and limited outcome variables. To provide a more granular evaluation of the impact of the recommendation, we analyzed our institution’s prostate cancer characteristics, 4 years pre- and post-recommendation. We then performed a quantitative synthesis of other primary data studies to produce an accurate and generalizable estimate of the immediate impact of decreased screening.

The goal of this paper, therefore, was to reinforce the prior population-based work by combining data from representative academic institutions. Indeed, in our meta-analysis including eight studies evaluating changes in Gleason Grade Group and D’Amico risk groups, we found an increased relative risk of both D’Amico high risk and Gleason Grade Group ≥4 disease (both p<0.01). No primary data studies in our systematic review, other than our institutional data, included metastatic disease at diagnosis, and we did not detect a difference pre- and post-recommendation (p=0.2). We also found evidence of an increase in ≥Gleason Grade Group 4 in the multivariable log-binomial regression of our institutional data (p<0.01), with a similar estimate to the pooled analysis (relative risk of 1.58 versus 1.50, respectively).

The USPSTF has since revised its recommendation to grade C. The period when screening was being discouraged by the task force offers an important opportunity to evaluate the real-world implications of decreased screening. We hope this summary of primary data studies can aid patients and providers in shared decision making on prostate cancer screening. Given the natural history of prostate cancer, long-term follow-up of these cohorts will be needed to establish whether these changing characteristics at diagnosis will impact overall or cancer-specific survival.

Written by: Matthew Clements, MD, Department of Urology, University of Virginia, Charlottesville, Virginia, USA

Reference:

Clements MB, Abdalla B, Culp SH, Costabile RA, Krupski TL. Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and Meta-Analysis [published online ahead of print, 2020 Aug 6]. Urol Int. 2020;1-7.

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