Prostate Cancer Incidence Rates 2 Years After the US Preventive Services Task Force Recommendations Against Screening | Cancer Screening, Prevention, Control | JAMA Oncology | JAMA Network
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    Effects of USPSTF Recommendations Against Prostate Cancer Screening
    Stephen B. Strum | Medical Oncologist Specializing in Prostate Cancer
    The research letter by Jemal et al is a clear-cut presentation indicating falling incidence rates of early stage prostate cancer (PC) in both younger and older men in chronological relationship to the USPSTF publication in 2012 (Jemal A, Ma J, Siegel R, et al: Prostate Cancer Incidence Rates 2 Years After the US Preventive Services Task Force Recommendations Against Screening. JAMA Oncol, 2016.) Whether or not these observations will impact the diagnosis of advanced stage PC will take additional years of follow-up.

    What concerns me as a medical oncologist that has focused on PC in the pre-PSA and post-PSA
    eras is the confusion between the value of an early diagnosis of malignancy versus the adverse outcomes affecting many of those diagnosed with PC. In my 33 years of experience consulting with men with PC from virtually every state and also other countries, these adverse outcomes relate to biopsy-associated infection and/or bleeding, & complications of surgical, radiation, or medical management of a significant percentage of these men. The underlying causes of such adverse effects are due to iatrogenic causes such as 1) poor technical biopsy skill, 2) poor clinical judgment resulting in overly aggressive treatment, and 3) human frailties involving misplaced motivations that are too distasteful to describe in detail.

    But what is missed in not making an earlier diagnosis is partly evidenced with the recent focus on so-called \"surveillance\". When a diagnosis of PC is associated with the recognition that many internal medicine issues are linked to PC, then the overall health of these men, diagnosed but not treated for PC, is greatly enhanced. Such interactive diseases include, but are not limited to bone loss, glucose intolerance, lipidemias, arteriosclerotic cardiovascular disease, obesity, inflammation, gonadal dysfunction, and secondary malignancies. The challenge that all of the above represents is how do we maximize the positive that we can do for such patients and minimize the negative? Educating the lay population, stricter guidelines for diagnosis and treatment-related procedures, changing the incentive from procedure-based to outcome-based, and perhaps creating an oncology specialty that is focused on this very problem i.e. distinguishing science from art and the lack of either are considerations. We did face a similar problem with breast cancer patients where woman were routinely being subjected to radical mastectomies, and this was dramatically changed via education and legislation. This just has not happened with men with PC.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    December 2016

    Prostate Cancer Incidence Rates 2 Years After the US Preventive Services Task Force Recommendations Against Screening

    Author Affiliations
    • 1Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
    • 2Office of Chief Medical Officer/Research, American Cancer Society, Atlanta, Georgia
    • 3Intramural Research, American Cancer Society, Atlanta, Georgia
    JAMA Oncol. 2016;2(12):1657-1660. doi:10.1001/jamaoncol.2016.2667

    We previously reported a substantial decline in early-stage prostate cancer incidence rates from 2011 to 2012 in men 50 years or older residing in areas covered by the population-based Surveillance, Epidemiology, and End Results (SEER) program.1 This pattern coincided with the decline in prostate-specific antigen (PSA) testing in this age group between 2010 and 2013 following the US Preventive Services Task Force recommendation against routine PSA testing in all men in October 2011 in draft form and in May 2012 in final form, which was preceded by a 2008 recommendation against PSA testing in men 75 years or older.2 Whether the decrease in incidence rates persisted through 2013 is unknown.

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