2012 US Preventive Services Task Force recommendation.

[pjoshea13]

New study below.

"We identified all prostate biopsies performed by a large urology group practice ..."

"A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 ..."

"The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014."

Golly! That was unexpected.

-Patrick

ncbi.nlm.nih.gov/pubmed/291...

Investig Clin Urol. 2017 Nov;58(6):423-428. doi: 10.4111/icu.2017.58.6.423. Epub 2017 Nov 2.

US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses.

Gejerman G1, Ciccone P1, Goldstein M1, Lanteri V1, Schlecker B1, Sanzone J1, Esposito M1, Rome S1, Ciccone M1, Margolis E1, Simon R1, Guo Y1, Pentakota SR2, Sadhegi-Nejad H1.

Author information

1

New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA.

2

Division of Urology, Rutgers New Jersey Medical School, Bloomfield, NJ, USA.

Abstract

PURPOSE:

To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted.

MATERIALS AND METHODS:

We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score.

RESULTS:

A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p<0.0001). Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores. Patients were about 1 year younger in 2014 compared to 2011 (t-test; p=0.043). High Gleason scores (8-10) were diagnosed in 19% of the 2014 positive biopsies versus 9% in the 2011 positive biopsies (chi square; p<0.0001).

CONCLUSIONS:

After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates. We found a significantly higher incidence of high grade disease in 2014 compared with 2011. The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014. The higher incidence of these more aggressive cancers must be part of the discussion regarding PSA screening.

KEYWORDS:

Diagnosis; Gleason score; Prostate neoplasms

PMID: 29124241 PMCID: PMC5671961 DOI: 10.4111/icu.2017.58.6.423

[cesanon]

hmmm so reduced PSA testing is causing a greater percentage of biopsies to generate more severe positive results.

Do they talk at all about an increase in the use of non-invasive diagnostic procedures such as all the new forms of imaging?

[pjoshea13]

The PCa "Industry", which profits from more biopsies & more detection has failed to respond to the USPSTF attack. The message in the media & in one's doctor's office has been that screening can (or even should) be skipped.

The rational response would be to use other markers, in addition to PSA, to cut down on biopsies, & Gleason 6 detection, and to get the message into the media that the USPDTF got it wrong but did have valid concerns that have since been addressed.

Instead, we have heard a lot of mumbling, & nothing positive being done to prevent excess Gleason 8-10 cases. Where is the concern for those men?

-Patrick

[Neal-Snyder in reply to pjoshea13]

Yeah, where was the concern from the urologists & oncologists (or even the task force)? It wasn't very hard to figure out what was going to happen, given that all of us members of the "prostate cancer community" could see that more guys were going to get diagnosed after they had more serious PCa. And few of us have an ounce of medical school. Many of us were even activists on the issue. At least WE had the concern. It kinda looks like the docs were uncaring, don't it?