U.S. County-level Study Shows Life-Saving Impact of PSA Screening

A lapse in screening can be costlyBy Deb Hickey

A new study of U.S. counties found that higher rates of prostate-specific antigen (PSA) screening are linked to lower incidences of advanced or metastatic prostate cancer and reduced prostate cancer mortality rates in subsequent years.  

USPSTF Recommendation Led to Disastrous Results 

In 2012, the U.S. Preventive Services Task Force (USPSTF) caused a significant stir by strongly recommending against prostate cancer screening. They argued that PSA testing led to over-treatment and harmed men who might otherwise have lived normal lives without experiencing prostate cancer symptoms.  

Following this recommendation, many physicians ceased screening their patients. Our members and many in the medical community were outraged. We were deeply concerned that discontinuing PSA testing would result in an increased number of undiagnosed, aggressive prostate cancers, which, if left untreated, could lead to metastasis and death. 

In 2017, there was a partial reversal of the 2012 panel’s recommendation, simply suggesting that 55-69-year-old men speak with their doctors about the advisability of getting a PSA test. However, the USPSTF still recommended against PSA testing for men 70 and older. There was also no mention of advances in use of biomarkers and genomic testing that could greatly reduce the chance of over-diagnosis and over-treatment.  

And, as we predicted, after the USPSTF’s initial recommendation, there was a significant increase in the number of older men reported to have distant metastases at diagnosis, as reported in JAMA Oncology. The increase rate was lower for those aged 50-74. 

Many prostate cancer experts believe that once prostate cancer metastasizes, it may be manageable but it’s not curable. At the very least, treatment after metastasis is much more expensive and generally more onerous than when it’s detected early and still organ-confined. So, the USPSTF recommendations resulted in many men experiencing tragic consequences.  

New Study Shows Benefits of PSA Screening 

Clinicians continue to debate the benefits and harms of PSA screening. To help clarify the value of PSA screening, researchers assessed the association between PSA screening rates by U.S. county and the incidence of metastatic prostate cancer and prostate cancer mortality by county. 

They analyzed data from 63.4 million men aged 40-79 across 3,143 counties from 2004 to 2012. The researchers found that a 10 percent increase in PSA screening during this period was associated with a 14 percent decrease in advanced prostate cancer cases from 2015 to 2019 and a 10 percent decrease in prostate cancer deaths from 2016 to 2020. 

The study also highlighted a significant connection between PSA testing rates and the number of men receiving prostate cancer treatment. For instance, in 1997, an additional 4,894 men underwent prostate biopsies and 1,597 more men received prostate cancer treatment per 100,000 men screened with a PSA test. 

“This population-based ecological study found that U.S. counties with higher rates of PSA screening had lower rates of metastatic prostate cancer and prostate cancer mortality in subsequent years,” the researchers concluded. 

The choice between screening and surveillance remains pivotal, empowering individuals to ascertain the nature of their cancer and tailor their treatment accordingly. Thus, while the concerns of overtreatment persist, the evolving paradigm suggests that routine screening should not be dismissed outright, underscoring the importance of informed decision-making by physicians as well as patients. 

Deb Hickey and Bob Marckini manage the Brotherhood of the Balloon (BOB), a 10,000-member organization of prostate cancer patients from all 50 states and 39 countries, in December 2000. Learn more about BOB.