Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA.
Division of Urology, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
World J Urol. 2019 Mar;37(3):489-496. doi: 10.1007/s00345-018-2407-3. Epub 2018 Jul 12.
In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality.
To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching.
Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8 ng/mL) and mean age (60.8-62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement.
All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.
2012 年 5 月，美国预防服务工作组发布了一项 D 级推荐，反对基于 PSA 的前列腺癌筛查。流行病学家担心，一个意想不到的后果是高危疾病的问题增加，随后前列腺癌特异性死亡率也会增加。
为了评估 PSA 筛查减少对根治性前列腺切除术后高危前列腺癌表现的影响。评估了 2008 年 10 月至 2016 年 9 月期间美国 9 个高容量转诊中心（n=19602），并通过倾向评分匹配比较了 GS≥8、精囊和淋巴结浸润的男性绝对数量。
与推荐前（2008 年 10 月至 2012 年 9 月）的 4 年平均水平相比，推荐后（2012 年 10 月至 2016 年 9 月）手术量减少了 22.6%，中位 PSA（5.1-5.8ng/ml）和平均年龄（60.8-62.0 岁）增加。低级别 GS 3+3 癌的比例显著下降（30.2-17.1%），而高级别 GS 8+癌的比例增加（8.4-13.5%）。GS 8+癌的绝对数量增加了 24%。一年生化复发率从 6.2%上升到 17.5%。为了辨别高危疾病的增加是否是由于转诊模式所致，进行了倾向评分匹配。经年龄和 PSA 调整后的优势比森林图显示，病理分期、分级和淋巴结受累均显著增加。
所有中心均经历了低级别疾病的持续减少，以及中高危癌症的绝对增加。对于任何给定的年龄和 PSA，倾向匹配显示出推荐后时代疾病更具侵袭性。
