San Antonio — Low Prostate-Specific Antigen (PSA) Screening Veterans Administration (VA) medical centers report high prostate-specific antigen (PSA) screening rates. metastatic prostate cancera recent retrospective analysis found.
Across 128 VA sites, PSA screening rates declined from 47.2% in 2005 to 37% in 2019, but there were metastases. prostate cancer Incidence increased from 5.2 per 100,000 to 7.9 per 100,000.
The current study is “very important because it showed that there was an increase in men presenting with end-stage prostate cancer in a group of patients for whom screening was not encouraged or performed,” says Jeff M. Michalski, MD, MBA, President, said American Society for Radiation Oncology (ASTRO) elected officials at a press conference.
“This is likely to lead to an increase in prostate cancer mortality in this patient population who were not given the opportunity to be screened,” added Michalski, of the Washington University School of Medicine in St. Louis, who was involved in the study. is not involved.
The study was presented at ASTRO’s annual meeting on October 25, publish online October 24th JAMA Oncology.
At a press briefing, PSA screening remains “controversial,” said study author Brent S. Rose, M.D., of the University of California, San Diego.
PSA screening became widely available in the 1990s, but the situation has changed as several randomized controlled trials have not shown consistent clinical benefits of PSA screening. 1 trial made in europe found a significant difference in prostate cancer mortality by screening, but one in america didn’t.
2012, United States Preventive Services Task Force (USPSTF) recommended for PSA screening in healthy men of all ages.
However, the debate about the value of PSA continues.
Results: “Physicians have very different ideas about the risks and benefits of prostate cancer screening,” said lead study author Alex K. Bryant, MD, University of Michigan Rogel Cancer Center, Ann Arbor, in a press release. said in
To provide some real-world evidence, researchers investigated PSA screening rates across all 128 VA facilities. These included annual in-house PSA screening rates and missed screening appointment rates. Between 2005 and his 2019 cohort of men, he increased from 4.7 million to 5.4 million.
Researchers found that PSA screening rates declined from a peak of nearly 51% in 2008 to 37% in 2019, with declines across all age and ethnic groups. During the same period, the team observed a corresponding increase in the rate of long-term non-screening, that is, the proportion of men who missed screening for three consecutive years. increased to a high of 33%.
Specifically, the incidence of metastatic prostate cancer rose from a low of 4.6 per 100,000 men in 2008 to 7.9 per 100,000 men in 2019.
Institutions with higher annual PSA screening rates had lower rates of subsequent metastatic prostate cancer. Every 10% increase in PSA screening rate was associated with a 9% reduction in the incidence of metastatic prostate cancer at 5 years (incidence ratio [IRR]0.91; P. < .001).
Conversely, facilities with lower annual screening rates had higher rates of metastatic prostate cancer at 5 years (IRR, 1.10; P. < .001). Furthermore, each 10% increase in long-term unscreened PSA rate was associated with an 11% increase in the incidence of metastatic prostate cancer at 5 years (IRR, 1.11; P. = .01).
The authors noted some limitations of their study. The analysis was retrospective and the veterans population may differ from the general population in age, comorbidities, environmental exposures, and socioeconomic factors.
Overall, however, the findings support PSA screening as a “beneficial intervention,” Rose said.
“While there are risks of overdiagnosis and overtreatment, there are also risks of underdiagnosis and undertreatment.
He explained that the reason the USPTF guidelines were changed in 2012 was to “dissuade the use of PSA screening to detect prostate cancer in asymptomatic men.”
“With this phenomenon of so many patients being diagnosed with cancers that aren’t actually life-threatening, we don’t want to go back to the days when everyone was screened in malls and every clinic,” Michalski said. said Mr. Medscape Medical News.
However, some men, such as those with a family history of the disease or those of certain ethnic or racial backgrounds, are “at increased risk of developing prostate cancer and therefore undergo targeted screening.” I need to,” he explained.
Marc B. Garnick, M.D., Ph.D., who was not involved in the study, said the study “makes a very important contribution to the ongoing debate about the value of PSA screening.”
Dr. Garnick of Harvard Medical School in Boston, Massachusetts said: Medscape Medical News “The increased incidence of metastatic disease associated with declining screening rates encourages further studies, preferably in randomized settings, and reconsideration of changes in screening policy, especially in older patients. It is necessary to determine whether there is
No funding for this study was reported. Rose has not disclosed any related financial relationships. Bryant is associated with Boston Consulting Group. Other authors have many ties to the industry.
American Society for Radiation Oncology (ASTRO) 2022 Annual Meeting: Abstract 298. Presented October 25, 2022.
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