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ASCO: High-Risk Prostate Cancer Diagnosis Up Since New PSA Recs

Researchers report 3 percent annual rise in intermediate- and high-risk cases

WEDNESDAY, Feb. 25, 2015 (HealthDay News) — U.S. recommendations against the prostate-specific antigen (PSA) test for prostate cancer might have prompted a small but measurable increase in the number of higher-risk cases diagnosed recently, according to a new study. Findings from the study are to be presented Thursday at the American Society of Clinical Oncology’s annual Genitourinary Cancers Symposium, held from Feb. 26 to 28 in Orlando, Fla.

The U.S. Preventive Services Task Force (USPSTF) in 2009 recommended that the PSA test not be used to screen men 75 years or older for prostate cancer, and in 2012 recommended that the PSA not be used for prostate cancer screening at all for any age group. Between 2011 and 2013, the study authors noted a 3 percent per year increase in the percentage of prostate cancer patients who had a PSA level of 10 or higher at the time of their diagnosis. The researchers discovered nearly double the increase — about 6 percent per year — for men 75 or older.

This trend suggests that an additional 14,000 men were diagnosed with higher-risk prostate cancer in 2014, and that an estimated 1,400 would have died from the disease that year, study coauthor Timothy Schultheiss, Ph.D., director of radiation physics at the City of Hope Medical Center in Duarte, Calif., told HealthDay. “We believe our data indicate that the USPSTF might reconsider their recommendation,” Schultheiss said. “We need to be intelligent about who we screen and who we treat. We’re not suggesting that everyone be screened using PSA, but we’re not suggesting that no one be screened using PSA.”

In response, USPSTF Chairman Michael LeFevre, M.D., M.S.P.H., told HealthDay that the study authors’ conclusions regarding the PSA test were premature and based on incomplete data. For example, “this study doesn’t appear to include data on the frequency of diagnosis of low-, intermediate- or high-risk prostate cancers in the U.S. population,” he said. Schultheiss said he and his colleagues did examine the severity of prostate cancer in the men studied, and those indicators “did not change appreciably during the same period of time.” Based on that statement and the findings presented, LeFevre said: “It is unclear, from the data made available to us at this time, how this study could be used to draw conclusions about the impact of the USPSTF’s 2012 recommendation on PSA screening for prostate cancer on the number of high-risk cancers being diagnosed either before or after the recommendation.”

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