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).
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.
Effect estimate: HR 1.2 (95% CI 1.1, 1.3)
Absolute Event Rate: 1.9% vs 1.6%
p-value: p=< 0.001
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.
Falkenbach et al. (Tue,) conducted a 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).