Implications of the United States Preventive Services Task Force Recommendations on Prostate Cancer Stage Migration

Abstract Purpose Prostate specific antigen screening is controversial. In 2008, the USPSTF recommended against screening men aged ≥75 and in 2012, expanded this to include all men. The impact of these changes continues to unfold. We hypothesized that these screening changes could delay the diagnosis of advanced PCa. Materials and Methods The Surveillance, Epidemiology, and End Results database was used to identify men (age 55-69) diagnosed with prostate cancer in 2004-2008 (group 1), 2009-2012 (group 2), and 2013-2015 (group 3). Groups reflect USPSTF guideline changes. Descriptive statistics were used to present baseline statistics and the number of patients diagnosed in aforementioned groups. Data was adjusted for population growth. Results 328,586 men were identified (group 1: 135,625, group 2: 117,979, group 3: 74,982). The average number of men diagnosed annually with N1M0 (group 1: 381, group 2: 477, group 3: 660) and M1 (group 1: 523, group 2:761, group 3: 1037) disease increased. With group 1 as control, there was a decrease in the incidence of localized disease (group 2: 9.2%, group 3: 33.2%). However, the incidence of N1M0 (group 2: 5.3%, group 3: 30.1%) and M1 disease (group 2: 22.6%, group 3: 49.2%) increased. Separate analyses of patients (age 50-75) and African Americans showed similar trends. Conclusion With each recommendation, there was increased incidence of de-novo metastatic prostate cancer. The sequelae of advanced disease include financial, emotional, and physical burden. Future studies are needed to identify screening strategies that reduce the risk of developing metastatic disease without over diagnosing indolent cancers.