About the lead author:
Kevin Su, BS
Mr. Su is a 4th year medical student currently attending Yale University School of Medicine
Timur Mitin, MD, PhD
Department of Radiation Medicine
Oregon Health & Science University
Prostate cancer represents a spectrum of disease that ranges from nonaggressive, slow-growing disease that may not require treatment to aggressive, fast-growing disease that does. Death rates for prostate cancer in the United States have fallen dramatically, largely due to early detection and improved treatment. Nevertheless, the screening of men for prostate cancer is probably the most hotly debated clinical topic in this country. In 2008, the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen-based screening program for men over age 75, and in 2012, for all men. Other expert physician organizations, including the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN), support prostate cancer screening with balanced and proper patient education preceding the PSA draw.
Significant flaws of the US randomized screening study, which largely formed the basis for the USPSTF recommendations, have been addressed by many leaders in the field of prostate cancer. The effect of this recommendation on the well-being of US men will take more years to become apparent; however its effect on the healthcare system is already obvious, with fewer patients being diagnosed with prostate cancer, leading to fewer referrals to urologists, medical, and radiation oncologists.
This manuscript documents a significant decrease in the volume of patients seen across all radiation oncology and urology clinics in Lee County in southwest Florida. The analysis does not prove that this trend is directly related to the USPSTF recommendations. Nevertheless, these findings are important for healthcare budgeting, physician training, and workforce allocation. It will be interesting to compare this trend to those seen at academic institutions across the country. With a longer follow-up, the authors are encouraged to re-evaluate the percentage of patients presenting with locally advanced and metastatic disease. Modeling studies will then be necessary to determine if these clinical outcomes are related to the USPSTF recommendations. One day, we will know whether the experts on the USPSTF panel got it right or wrong. Time will tell.
Background: In 2008, the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen-based screening for prostate cancer in men age ≥75, and in 2012, recommended against screening in all men. It is unknown how these guidelines have impacted patient presentation to radiation oncology care.
We conducted a retrospective study of patients presenting with localized prostate cancer to 21st Century Oncology radiation oncology clinics in southwest Florida, which supply nearly all radiation oncology services for the region. We assessed trends in patient volume and the risk distribution of a random sample of patients (using National Comprehensive Cancer Network risk criteria) to estimate the total patient volume within each risk group.
Results: From 2007 to 2013, the number of patients presenting with prostate cancer decreased from 1,860 to 1,209 (p <.001). The estimated number of low-risk patients decreased from 858 (779-939) to 354 (307-405), as did the number of intermediate-risk patients, from 657 (583-736) to 506 (454-560). There was no significant change in the number of patients with high-risk (323 [267-389] to 312 [267-361]) or metastatic disease (22 [10-48] to 37 [23-61]). Similar trends held in all age groups, except intermediate-risk disease decreased significantly for men ≥75 years, but not younger men.
USPSTF guidelines may have decreased the number of patients presenting with prostate cancer for radiation oncology care, particularly those with low-risk disease, without a short-term increase in higher-risk disease. Future research should assess the longer-term impact of these guidelines nationally.
Prostate cancer is the most common cancer among males in the United States, with an estimated 233,000 new cases in 2014.1
Because a large proportion of men with prostate cancer do not experience symptoms during their lifetime, the significant increase in the incidence of prostate cancer since the introduction of prostatespecific antigen (PSA)-based screening has raised concerns of overdiagnosis and overtreatment.2
In 2008, the US Preventive Services Task Force (USPSTF) issued a recommendation against PSA-based screening for prostate cancer in men age ≥ 75,3 which was expanded in 2012 into a recommendation against screening in all men.4 These guidelines have generated substantial controversy, with some professional societies and patient advocacy groups arguing that screening can reduce mortality.5-8