Tudor Borza, MD
A sharp decline has been observed in the overall rate of men receiving treatment for prostate cancer, according to the results of a study published in Health Affairs
This decline is potentially attributed to recent changes in guideline recommendations that suggest that there is widespread overdiagnosis and overtreatment in the prostate cancer treatment paradigm.
The study found that population-based treatment rates declined by 42%, while rates among diagnosed men declined by only 8%.
“It was surprising to see such a big decrease,” said study author Tudor Borza, MD. “We didn’t know how much of an uptick there would be by primary care doctors in terms of decreasing their PSA screening and how that would translate to men getting treated.”
In an interview with OncLive
, Borza, a urologic oncology and health services research fellow at Michigan Medicine, discusses the major findings of his study and his stance on the importance of prostate cancer screening and treatment.
OncLive: What was the rationale for collecting these data about men with prostate cancer?
: We wanted to look at this particular rate of treatment because, over the last decade or so, there have been many changes in the recommendations for prostate cancer screening and the way that men with prostate cancer are treated. In our paper, we looked at the changes in national screening recommendations made by the US Preventive Services Task Force. which, in 2009, recommended against screening for prostate cancer in men older than 75. And then in late 2011/early 2012, they recommended against all PSA screenings for prostate cancer, saying that the harms from screening were greater than the harms from treatment. Obviously, there’s a lot of press that surrounded that decision, and many physicians changed the way they practice medicine because of that.
Similarly, professional organizations that guide how specialists do their jobs, like the American Urological Association (AUA), and the NCCN, also changed their screening recommendations, though not to the same degree. Most specialists and national organizations still recommend PSA screening, now in different groups of men, but they still recommend that it be done.
At the same time, because of the known overdiagnosis and overtreatment of prostate cancer, specialists started to use surveillance strategies—either watchful waiting for men who don’t have a long life expectancy, or active surveillance for men with low-risk prostate cancer. Both of these have been shown to be as effective as upfront treatment. We’ve started using these surveillance strategies with the goal of avoiding unnecessary treatment in some of these men.
All of these things were happening over the period of time that we conducted our study. We wanted to get an idea of what the effect was on treatment from this overall change in thinking, and really try to tease out whether the screening recommendations or the use of surveillance had more of an impact on the treatment rates.
What were the most significant findings from your study?
We looked at the treatment rates in the population as a whole—that’s all men who could possibly be screened for prostate cancer in our Medicare sample. We found that that treatment rate decreased by 42%. It went from 4.3 per 1000 men to 2.5 per 1000 men getting treated, and that’s a big drop.