Lower Number Of Prostate Cancer Screening Missing Serious Cases, Reveals Study

Researchers at the Weill Cornell Medicine have discovered that the decision by public health authorities to downgrade recommendations for the prostate-specific antigen or PSA test as a screening tool to bring down the overdiagnosis and overtreatment of men with low-grade prostate cancer is not a correct one. The research was recently published in the Journal of the National Cancer Institute.

Commenting on the study findings, senior author Dr Jim Hu said, "To our knowledge, this is the first study to demonstrate nationally that low-grade prostate cancer is no longer the most commonly diagnosed type of prostate cancer. One of the weaknesses of PSA/prostate cancer screening was that it led to over-detection of indolent cancers that would not harm men, subjecting them to anxiety and future testing."

In 2012, the US Preventative Services Task Force or USPSTF had recommended against screening all men with the PSA test, observing that the benefits of the test, which is a measure of the levels of a protein often overproduced in prostate cancer cells, did not exceed the risks. So in 2018, the USPSTF issued a revision to include shared decision making for the PSA test for men aged 55 to 69 years, a conclusion of upcoming evidence of longer-term benefits and high vigilance after detection of the low-risk disease.

For their study, Dr. Hu and his team studied over 438,000 men with newly diagnosed prostate cancer between 2010 and 2018, using a national database. They examined the trends in the cases of prostate cancer by disease risk with several measures. One measure was the Gleason Grade, a pathology score based on the microscopic appearance of the prostate cells, determined at biopsy and after radical prostatectomy, a procedure in which the entire prostate is surgically removed. Additional measures were PSA level and presence of metastasis at diagnosis.

The analysis revealed a significant decrease in the incidence of the lowest-risk prostate cancer, Gleason Grade 1 (GG1), falling from 52 to 26 cases per 100,000 men across all age groups. Also, the proportion of GG1 found on pathology in men who had a radical prostatectomy fell from 32 to 10 percent. However, metastases rates at diagnosis increased from 3.0 percent to 5.2 percent over the same period. They concluded that the stopping of PSA testing was the main reason behind these findings.

Dr Hu said, "The fact that only 10 percent of radical prostatectomy specimens demonstrate low-grade prostate cancer indicates that even when low grade cancer is diagnosed, it is being treated much less frequently. This demonstrates that there has been acceptance of active surveillance, also known as monitoring with curative intent, among doctors and patients nationally."

The study concluded that public health authorities should implement risk-stratified screening, like MRI or biomarkers, thus lowering the chances of overdiagnosis and avoid biopsy in men with low-risk prostate cancer while looking into the increasing cases of high-grade and metastatic prostate cancer.

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