Re-considering PSA Screening Strategies to Catch Aggressive Cases

The number of new cases of metastatic prostate cancer climbed 72 percent from 2004 to 2013, according to a controversial new study published July 19 in Prostate Cancer and Prostatic Diseases. The investigators say they can’t definitively link the increased cases to reduced prostate cancer screening and the rise could reflect the disease becoming more aggressive. However, the largest increase in new cases was among men 55 to 69 years old, which rose 92 percent.

While data shows metastatic disease began rising in 2008, before the 2012 change in screening recommendations by the U.S. Preventive Services Task Force, the authors say the sharp rise in advanced disease in 55- to 69-year old men is “particularly troubling” because these men may be most affected by changing screening guidelines and may benefit most from screening and early treatment. “The results indicate that screening guidelines and treatment need to be refined based on individual patient risk factors,” said lead author Adam Weiner, M.D., a Northwestern University urology resident. “This may help prevent the growing occurrence of metastatic prostate cancer and potential deaths associated with the disease. This also can help minimize overdiagnosing and overtreating men with low-risk prostate cancer who do not need treatment.” Separate studies are beginning to assess new screening strategies. For further discussion, see the August issue of Diagnostic Testing & Emerging Technologies.