Prostate Cancer Research Highlights

Are PSA Tests to Screen for Prostate Cancer Underutilized?

Each year the American Cancer Society Surveillance & Health Equity Science team analyzes data on cancer in the United States, including prostate cancer, as part of its Cancer Statistics report in CA: A Cancer Journal for Clinicians. The report is accompanied by an educational publication, Cancer Facts & Figures.

These publications provide detailed analyses and estimates of prostate cancer incidence, survival, and mortality trends in the US. They also have the latest information on cancer risk factors, early detection, treatment, and current research.

US 2022 Statistics for Prostate Cancer

• Other than skin cancer, prostate cancer is the most common type of cancer in men. About 1 in 8 men will be diagnosed with prostate cancer in their lifetime.
• The incidence of prostate cancer is about 73% higher in Black men than in White men for reasons that remain unclear. In fact, Black men in the US and Caribbean have the highest documented prostate cancer incidence rates in the world. 
  
• Smoking and excess body weight are the two risk factors that people with prostates may be able to change to lower their chances for developing an aggressive or fatal form of prostate cancer. 
• Prostate cancer is the second-leading cause of death from cancer in men. Lung cancer is the first. About 1 man in 41 will die of prostate cancer. 
  

How Changes in PSA Screening Are Affecting Incidence and Risk of Death

The risk of dying from prostate cancer decreased by about 50% from the mid-1990s to the mid-2010s due to improved treatment and earlier detection through screening with prostate specific antigen (PSA) testing, which helps find cancer when it is only in the prostate (localized). But in recent years, the risk of dying from prostate cancer is only decreasing by 0.6% a year. The cause for this slowing progress may be related to changes in screening guidelines.

Despite the contribution of screening to a reduction in mortality, there was increasing evidence that PSA testing was causing undue harm through overdiagnosis and overtreatment of prostate cancer. As a result, the US Preventive Services Task Force (USPSTF) changed their screening guidelines.

In 2008, the USPSTF recommended against routine screening with PSA testing for men age 75 and older and in 2012 for all men, which led to fewer men being screened.

At first, reduced PSA testing was followed by rapid declines in the diagnosis of prostate cancer. But from 2014 to 2018, the incidence rate for local-stage disease stayed stable, whereas incidence rates for regional-stage disease rose each year by 4% and by 6% for distant-stage disease.

As a result, the proportion of prostate cancers diagnosed at an advanced stage has more than doubled over the past 10 years, from 3.9% to 8.2%.

ACS researchers note that “controversy remains about the underutilized potential of the PSA test” to reduce deaths from prostate cancer by detecting potentially fatal disease earlier.

“One study found that after the 2012 USPSTF guideline changes, there was a steeper drop in PSA testing in Black men than in White men,” says Rebecca Siegel, MPH, lead author of Cancer Statistics, 2022, and Senior Scientific Director of Surveillance Research at ACS. “That’s concerning because early detection is especially important for Black men, who are twice as likely to die from prostate cancer as White men.” See the ACS Guidelines for Screening and Early Detection of Prostate Cancer.