5 Years After Guidelines Recommend Against Routine Prostate Cancer Screening, Later Stage Cancers Continue to Increase—for Unknown Reasons

Researcher: Ahmedin Jemal, DVM, PhD
Institution: American Cancer Society
Area of Focus: Surveillance and Health Equity Science

The Challenge: In 2008, the US Preventive Services Task Force (USPSTF) recommended against regular prostate- specific antigen (PSA) screening for men age 75 and older, and 4 years later, in 2012, they recommended against routine PSA screening for all men. (See current ACS recommendations for prostate cancer early detection.)

Since then, using data through 2015, studies have reported that incidence rates for prostate cancer confined to the prostate (local-stage disease) have declined, but incidence rates have increased for prostate cancer that’s spread to areas near and far from the prostate, known as regional- and distant-stage disease, respectively.

However, those studies did not include the most recent data available through 2016.

The Research: A study led by the Senior Vice President of ACS’s Surveillance & Health Equity Science division, Ahmedin Jemal, DVM, PhD, examined trends in invasive prostate cancer incidence rates from 2005 to 2016 in men according to stage at diagnosis, age, and race and ethnicity using a nationwide incidence database. It was published in the Journal of the National Cancer Institute (JNCI).

Jemal and his team found that from 2007 to 2016, for men of all races and ethnicities age 50 and older, prostate cancer incidence rates continued to decline when the cancer was localized or still confined to the prostate. For men age 75 and older, the rates stabilized during 2013 to 2016.

But for men age 50 and older, during the same time span, the incidence rate persistently increased when cancer had spread—near or far—from the prostate.

These data illustrate the trade-off between higher screening rates and more early-stage disease diagnoses—possibly overdiagnosis and overtreatment—and lower screening rates and more late-stage—and possibly fatal—disease, the authors said.­­

For instance, they found that for men ages 50 to 74, a substantial decline in racial disparity in the incidence of advanced disease for men coincided with a steeper increase in advanced cancer incidence in White men. In other words, after the change in screening guidelines, the incidence rate for White men rose to match the incidence rate for Black men.

Still, compared to White men age 75 and older, incidence rates for more advanced stage prostate cancer was 65% higher in Black men of that age. The researchers don’t fully understand the reason for this this disparity continues to exist. They think it may partly reflect differences in lifestyle factors, biological susceptibility, and access to quality care.

Why Does It Matter? The increases in advanced prostate cancer incidence has public health implications, as later stages of prostate cancer are linked with multiple health issues and premature death. Future studies are needed to better understand the reasons for the rising trends in more advanced stages of prostate cancer and the disproportionately high burden of the disease in Black men.