Johnie Rose, MD, PhD
Invited study discussant, Johnie Rose, MD, PhD, noted that screening is a complex problem that requires balancing the risks of avoidable metastatic prostate cancer with the serious complications associated with treatment. Dr. Rose is Assistant Professor at the Center for Community Health Integration at Case Western Reserve University School of Medicine and Co-Director of the Case Comprehensive Cancer Center Population Cancer Analytics Shared Resource at University Hospitals Cleveland Medical Center.
“How to approach prostate cancer screening is one of the most important and difficult cancer control topics of our time, and this is a provocative finding,” said Dr. Rose, who commended the large number of subjects included in the analysis.
Looking Beyond the Study Findings
However, Dr. Rose also mentioned some study limitations, including potential issues with the makeup of the post-USPSTF [U.S. Preventive Services Task Force] population vs the pre-USPSTF population driven by the Affordable Care Act. Although this inherent “selection bias” does not negate the findings, he said, it should inform future research that needs to be conducted.
“The number of men diagnosed dropped by 18% after the USPSTF recommendation, and local prostate cancer diagnosis was much lower in the post-USPSTF period. However, I think it’s important to point out that these were already trending down,” Dr. Rose continued. “We cannot say with certainty that this decrease was due entirely to changing USPSTF -recommendations.”
After the USPSTF recommendation, Dr. Rose also noted that the prevalence of distant-stage cases started to increase slightly. “Given the greater lethality of metastatic disease, we would expect mortality eventually to come up or level off,” said Dr. Rose. “The trajectory of the ongoing mortality decrease does appear to have flattened, but we cannot tell whether that’s due to the policy change from this study.”
According to Dr. Rose, previous analysis of Surveillance, Epidemiology, and End Results data also identified an increase in the incidence rate of metastatic prostate cancer per 100,000 men after the recommendation change, especially among those 75 years or older.1 Thus, he encouraged future studies to look further at outcomes with screening plus active surveillance.
“As active surveillance is increasingly practiced, how much benefit can we gain by preventing more cases of overtreatment?” asked Dr. Rose. “Modeling studies are needed to answer this question and to identify those people who are are most likely to benefit from screening.”
DISCLOSURE: Dr. Rose reported financial relationships with Vinya Intelligence.
REFERENCE
1. Butler SS, Muralidhar V, Zhao SG, et al: Prostate cancer incidence across stage, NCCN risk groups, and age before and after USPSTF Grade D recommendations against prostate-specific antigen screening in 2012. Cancer 126:717-724, 2020.
