Key result
USPSTF recommendation against PSA screening linked to ~20% higher prostate cancer mortality in patients under 75.
Why the study?
Although the 2012 USPSTF recommendation against PSA screening resulted in unfavorable changes in prostate cancer outcomes, its effect on cancer-specific mortality in localized prostate cancer had not been assessed.
Does the USPSTF recommendation against PSA screening increase cancer-specific mortality in patients with localized prostate cancer?
Observational (n=303,780)
Yes
Does the USPSTF recommendation against PSA screening increase cancer-specific mortality in patients with localized prostate cancer?
The 2012 USPSTF recommendation against PSA screening was associated with a 1.2-fold higher cancer-specific mortality at 6 years in localized prostate cancer patients aged < 75 years.
Answers are grounded in this paper and cite their sources.
May raise localized prostate cancer mortality after reduced screening; leaves open causal confirmation in prospective trials.
BACKGROUND: The USPSTF recommendation against PSA screening (RAPS) in 2012 resulted in unfavorable changes in prostate cancer (PCa) outcomes. However, the effect on cancer-specific mortality (CSM) in localized PCa has not been assessed. METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2021), we identified patients treated with radiotherapy (RT) or radical prostatectomy (RP) for localized PCa. Time trends were examined using least-squares linear regression. Multivariable Cox regression was used to study the association between RAPS and PCa-mortality. RESULTS: Of 270,092 patients aged < 75 years, 191,621 (70.1%) were treated before and 78,471 (29.1%) in the RAPS era. CSM at 6 years of follow-up was 1.6% (95% confidence interval [CI]: 1.6, 1.7) before and 1.9% (95%CI: 1.8, 2.0) in the RAPS era (p < 0.001). In multivariable Cox models adjusted to patient characteristics, RAPS era independently predicted 1.2-fold higher CSM overall (95%CI: 1.1, 1.3; p < 0.001), 1.3-fold higher CSM in RP-patients (95%CI: 1.1, 1.4; p < 0.001), and 1.1-fold higher CSM in RT-patients (95%CI: 1.02, 1.2; p = 0.02) aged < 75 years. Of 33,688 patients aged ≥ 75 years, 12,485 (37.1%) were treated before and 21,203 (62.9%) in the RAPS era. CSM at 6 years of follow-up was 4.2% (95%CI: 3.8, 4.6) before and 4.8% (95%CI: 4.5, 5.1) in the RAPS era (p = 0.002). In multivariable Cox models adjusted to patient characteristics, RAPS era did not predict higher CSM overall, in RP-patients, or in RT-patients (all p ≥ 0.5) aged ≥ 75 years. Limitations include changes in early detection and disease management over time, which might have impacted CSM as well. CONCLUSIONS: The USPSTF RAPS introduction resulted in a 1.2-fold higher CSM in localized PCa patients aged < 75 years, but not in patients aged ≥ 75 years. The time trend analysis suggested that this negative effect has become increasingly pronounced since the USPSTF RAPS.
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Falkenbach et al. (2025) conducted an observational in Localized prostate cancer (n=303,780). USPSTF recommendation against PSA screening (RAPS) era vs. Before RAPS era was evaluated on Cancer-specific mortality (CSM) in patients aged < 75 years (HR 1.2, 95% CI 1.1, 1.3, p=< 0.001). The USPSTF recommendation against PSA screening was associated with a 1.2-fold higher cancer-specific mortality in localized prostate cancer patients aged <75 years (HR 1.2; 95% CI 1.1-1.3; p<0.001).
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