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Advanced Prostate Cancer Increasing for Men Over 50

Five years after the USPSTF recommended against PSA screening for all men, the rates of regional- and distant-stage prostate cancer is on the rise in men age 50 and above.

Five years after the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen-based (PSA) screening for all men, the rates of regional- and distant-stage prostate cancer is on the rise in men age 50 and above, according to a study led by American Cancer Society investigators. The study, published in JNCI, the Journal of the National Cancer Institute, reported that this rise in cancers that had spread out of the prostate gland was accompanied by a decrease in early-stage prostate cancer in the same period.

In 2008, the USPSTF started to recommend against PSA screening for men 75 and older, and in 2012, it made the same recommendation for all men. And in 2018, the task force said men 70 and over should not be screened and recommended individual decision-making regarding the screening for men ages 55 to 69. As a result, past-year routine PSA testing rates in men aged 50 and above fell from 40.6% in 2008 to 38.3% in 2010 to 31.5% in 2013. In 2015, the rates remained unchanged. Earlier studies found that prostate cancer rates had declined for local-stage disease but increased for regional- and distant-state disease after the USPSTF recommendations against routine screening.

The current study in the Journal of the National Cancer Institute focused on whether these incidence rates were held through 2016. Led by Ahmedin Jemal, DVM, Ph.D., researchers from the American Cancer Society focused on data from the US Cancer Statistics Public Use Research Database to examine the trends in invasive prostate cancer incidence in men 50 and older between 2005 and 2016. The men were stratified by race/ethnicity, stage, and age group. The researchers learned that the incidence of local-stage prostate cancer fell by 6.4% per year in men 50 to 74 from 2007 to 2016. The incidence fell by 10.7% in men 75 and older from 2007 until 2013 and then stabilized from 2013 to 2016. Yet the incidence of advanced prostate cancer rose in both age groups during the study period. Between 2010 and 2016, for instance, distant-stage prostate cancer increased by 5.2% annually in men aged 75 years or older.

In a telephone interview, Dr. Jemal said it is important for healthcare providers to educate their patients about the risks and benefits of PSA screening. “Men need to be told about the uncertainty of PSA testing and the benefits and harms associated with it,” he said. “If a man has a PSA screening and tests positive, then a biopsy is typically recommended, and this can lead to bleeding and infection. But it could be a false positive.” And it’s also important for patients to understand that an elevated PSA does not automatically signify prostate cancer. Prostatic hyperplasia and inflammation of the prostate gland can also cause this number to be elevated, he said.

Healthcare providers should tell their patients that if they score in the normal range on the PSA screening, they can repeat the screening every four or five years rather than annually.

“Men should be told that there are strategies to maintain the benefits of PSA testing while minimizing the harm associated with it,” Dr. Jemal said.

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