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?
303,780 patients with localized prostate cancer treated with radiotherapy (RT) or radical prostatectomy (RP) from the SEER database (2004-2021), including 270,092 aged < 75 years and 33,688 aged ≥ 75 years.
Treatment in the USPSTF recommendation against PSA screening (RAPS) era
Treatment before the RAPS era
Cancer-specific mortality (CSM) at 6 years of follow-uphard clinical
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.
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Fabian Falkenbach
Universität Hamburg
Francesco Di Bello
Puigvert Foundation
Natali Rodriguez Peñaranda
University of Modena and Reggio Emilia
The Prostate
Cornell University
The University of Texas Southwestern Medical Center
Université de Montréal
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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).
synapsesocial.com/papers/6a1826b4d990e918e6b4f692 — DOI: https://doi.org/10.1002/pros.70045