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National prostate biopsy and radical prostatectomy volumes decreased significantly following recommendation against PSA screening

Wednesday, November 2, 2016

A new study has found that the rate of prostate biopsies and radical prostatectomies decreased following a 2012 United States Preventative Task Force (USPSTF) recommendation against prostate specific antigen (PSA) testing. Researchers from NewYork-Presbyterian and Weill Cornell Medicine share their findings in this week’s JAMA Surgery.

Jim Hu, M.D.Jim Hu, M.D. “This is the first study to evaluate national trends in both procedures following the USPSTF recommendation, which we now believe to be based on faulty methodology,” said Dr. Jim Hu, director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center and the Ronald Lynch Professor of Urologic Oncology at Weill Cornell Medicine.Prostate biopsies and radical prostatectomies are used to test for and treat prostate cancer, respectively. These procedures typically occur when a patient is found to have elevated PSA levels. The USPSTF recommended against PSA testing in 2012 as a result of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial due to concerns about over-diagnosis and over-treatment for non-life threatening cancers, but earlier this year, NewYork-Presbyterian and Weill Cornell Medicine researchers argued that the methodology behind that study was flawed in a perspective piece for the New England Journal of Medicine.

The researchers looked at the volume of prostate biopsies and radical prostatectomies performed by urologists from 2009 to 2016. Prior to the USPTF’s recommendation in 2012, the median number of biopsies performed per urologist per year was 29, and the median number of radical prostatectomies was seven per urologist per year. After the recommendation, those figures dropped to 21 biopsies and six radical prostatectomies per urologist per year, an overall decrease of 28.7 percent and 16.2 percent respectively. The significant drop in these figures may mean that some potentially life-threatening cancers went undiagnosed or untreated. The same investigators demonstrated in European Urology that during the same study period, men are more likely to have prostate cancer spread to the lymph nodes during radical prostatectomy following the recommendation against PSA screening.

Prostate cancer remains the second leading cause of cancer death among American men and is the most common cancer in men other than skin cancer. However, some prostate cancers are less aggressive than others, and urologists may recommend forgoing treatment in favor of active surveillance since treatment may cause side effects for patients and decrease their overall quality of life. Moreover, with slow-growing prostate cancers and advanced age, some men are more likely to die with, rather than from, their prostate cancers. However, the declining number of biopsies overall was accompanied by a 29 percent increase in the proportion of biopsies performed due to active surveillance, or monitoring slow-growing prostate cancers.   

“We hope that this study engenders further discussion and reevaluation of the USPSTF recommendation regarding PSA screening, particularly in light of additional research from our group demonstrating the pitfalls of the trial upon which this recommendation was based,” said Dr. Hu, who is a member of the Speakers’ 18 Bureau for Intuitive Surgical and Genomic Health. “Physicians and policy makers must understand the potential consequences of the USPSTF and other screening recommendations in order to inform future policy and clinical guidelines. Patients should continue to have discussions with their physicians regarding the risks and benefits of prostate cancer screening on an individualized basis.” 

The study includes authors from NewYork-Presbyterian, Weill Cornell Medicine, Columbia University Medical Center and the University of Texas MD Anderson Cancer Center.

Additional coverage:

Prostate Surgery Rates Fall After Screening Advice, Study Finds - NBC News

Sharp drop in prostate cancer procedures after PSA screening curb - Reuters

Prostate Surgery Numbers Down As More Men Follow USPSTF Prostate Cancer Screening Guidance - TechTimes

Big Drop in Prostate Biopsies, Prostatectomies in US - MedScape