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Jump in Metastatic Prostate Cancer after end of routine PSA screening

The incidence of metastatic prostate cancer, cancer that spread from the prostate, shot up in the United States after after an official recommendation not to routinely screen men with the prostate-specific antigen (PSA) test, according to a new study.

The thinking was that the harms of screening all men — leading to unnecessary prostatectomies and other treatments in many men — outweighed the benefits of catching early high-risk disease in fewer men. Screening rates plummeted as a result.

But experts in prostate cancer warned that the move, while reducing overdiagnosis and overtreatment, would have the unfortunate consequence of underdiagnosis and, consequently, nondetection of the cases of prostate cancer that would spread.
The new findings are the latest to suggest that this is, in fact, what happened.

For this study, investigators at the University of Southern California, Los Angeles, led by Mihir M. Desai, MD (above) analyzed the incidence of metastatic prostate cancer from 2004-2018.

Among men 45-75 years old, the incidence of metastatic prostate cancer increased 41 percent from the time of the recommendation against screening through 2018, which translated to an annual percentage change of 5.3 percent. Among men 75 years and older, the rates jumped 43 percent through 2018, an annual percentage change of 6.5 percent.

The increased rates occurred equally among White, Black, and Hispanic men.The researchers did not find an increase in deaths from prostate cancer, but given the 5-7 years median survival, it might be too early to tell.

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