By Dr. David Samadi
A new study has found that prostate cancer death risk is lower where the prevalence of PSA screening is high. This finding is good news for men everywhere in that it strengthens the notion that this screening test for prostate cancer, does have benefits for men and their mortality.
Prostate cancer stands as a prominent contributor to cancer-related morbidity and mortality, responsible for a substantial number of new cases and fatalities annually among men worldwide. For the year 2024, the American Cancer Society estimates that 299,010 new cases and 35,250 deaths among American men will occur.
Despite the significance of this health concern, the understanding of modifiable risk factors remains limited, thereby constraining primary prevention strategies. The utilization of prostate-specific antigen (PSA) screening, while widespread in the United States, has had a contentious relationship with various organizations that did not recognize its benefits.
In 2012, prompted by sparse evidence of survival advantages from clinical investigations, the United States Preventive Services Task Force (USPSTF) advised against PSA screening. Consequently, a decline in screening rates ensued, paralleled by a concerning rise in metastatic prostate cancer cases. Early reports hinted at a regression in the progress made toward reducing prostate cancer-specific mortality. These alarming trends prompted the USPSTF to slightly amend its recommendations in 2018, advocating for shared decision-making regarding PSA screening, particularly among individuals at heightened risk of aggressive prostate cancer. The potential benefits of earlier detection, it posited, might outweigh the risks of overtreatment.
Is the PSA test beneficial or not?
PSA screening for prostate cancer remains a subject of debate but might confer benefits for specific high-risk groups. To delve into this matter further, a study evaluated county-level PSA screening prevalence and its associations with prostate cancer outcomes, considering variations across the sociodemographic and clinical spectrum.
Study methods and design
This cohort study leveraged data from cancer registries spanning eight US states, focusing on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years diagnosed with prostate cancer between 2000 and 2015. Participants were meticulously tracked until death or for a maximum of 10 years, with data analysis conducted between September 2023 and January 2024.
Among the 814,987 men with prostate cancer included in our study, notable findings emerged. Those residing in counties with the highest quintile of PSA screening prevalence at diagnosis exhibited reduced odds of advanced disease, lower all-cause mortality, and diminished prostate cancer-specific mortality compared to their counterparts in counties with lower screening rates.
Study strengths and limitations
While the study boasts considerable strengths, including its expansive scope, integration of neighborhood contextual factors, and demographic diversity, several limitations warrant acknowledgment. The absence of participants’ actual screening histories necessitates a nuanced interpretation of our findings, as our exposure variable primarily reflects the availability of PSA screening resources within their county of residence.
Conclusion
In conclusion, our population-based cohort study offers compelling evidence suggesting an inverse relationship between county-level PSA screening prevalence and adverse prostate cancer outcomes. However, these associations manifest variably across age groups, racial and ethnic categories, and geographic regions delineated by the US Census. Such insights underscore the nuanced interplay between screening practices and prostate cancer outcomes, advocating for tailored approaches informed by multifaceted considerations.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.