Prostate Cancer:
Start the Screening Conversation

Updated prostate cancer screening guidelines recommend a shared decision-making approach with patients.1,2 Talking to your patients about prostate-specific antigen (PSA) screening can have a major impact.

Prostate cancer is a commonly diagnosed cancer in the United States

In 2020, it was estimated that, in the US, prostate cancer will have continued to be the

#1

#1 cancer diagnosed in men,
excluding skin cancer3

(191,930 of 893,660 total new male
cancer cases)

#2

#2 cause of cancer deaths in men,
excluding skin cancer3

(33,330 of 321,160 total male
cancer deaths)

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A SEER analysis estimated patients with metastatic castration-sensitive prostate cancer (mCSPC) have reduced survival rates4

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  • A retrospective analysis estimated a 5-year relative survival rate for mCSPC patients of about 30.2% vs nearly 100% in patients with clinically localized or regional disease
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The data presented above are United States statistics.

SEER, Surveillance, Epidemiology, and End Results.

Previous guidelines may have contributed to lowered PSA screening rates

Over the past decade, PSA screening rates have declined due in part to previous US Preventive Services Task Force (USPSTF) recommendations aimed to reduce potentially unnecessary treatment6

PSA screening rate decline, 48% in 2008 to 39% in 2018
  • In a retrospective study of data collected from 2008 to 2014 in one hospital, the largest decline in the PSA screening rate occurred in patients aged 55-69 years, when patients are most likely to develop prostate cancer (average age at diagnosis is approximately 66 years)8,9
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60% decline

In early 2020, one insurance report analyzing claims data estimated that PSA screening rates dramatically decreased due to the decline of in-office visits10

60% decline

From February 2020 to April 2020, there was an estimated 60% decrease in PSA screening tests performed, mostly due to a decline of in-office visits because of COVID-1910

One study suggests that prostate cancer biopsy rates have declined, and biopsy positivity has approximately doubled

Annual prostate biopsy rates have declined, as shown in one study11

537 in 2010 to 2012 versus 398 in 2015-2017 equals 30% reduction More information

The percentage of prostate biopsies positive for cancer has approximately doubled11

23.6% nearly doubled to 46.2% More information
Metastasis on human icon

Tumor stage at prostate cancer diagnosis has worsened, with distant stage (metastatic) cancer diagnoses on the rise12

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The incidence of patients diagnosed with metastatic prostate cancer at initial clinical presentation is expected to rise by 19% from 2020 to 202513

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Current guidelines on prostate cancer screening recommend shared decision-making

USPSTF

USPSTF recommendations for prostate cancer screening (2018 update)1

USPSTF
  • For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician
  • In determining whether a PSA screening is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of:
    • Family history
    • Comorbid medical conditions or other health needs
    • Race/ethnicity
    • Patient values about the benefits and harms of screening and treatment-specific outcomes
AUA

American Urological Association (AUA) guidelines on early detection of prostate cancer (2018)2

AUA
  • For men aged 55 to 69 years, shared decision-making is strongly recommended to weigh the benefits of reducing the rate of metastatic prostate cancer and prevention of prostate cancer death against the known potential harms associated with screening and treatment
  • Screening decisions should be individualized for men under age 55 who are at higher risk, which may include African American men and men with a family history of metastatic or lethal adenocarcinomas spanning multiple generations, affecting multiple first-degree relatives, and that developed at younger ages

The most important risk factors in prostate cancer are

Age

Age

Men ≥ 65 years old are ~14x more likely to develop prostate cancer than men < 65 years old (based on SEER data from 2017).4

Race

Race

The overall mortality rate due to prostate cancer in African Americans in the United States is 2x the rate in Caucasians (based on SEER data from 2013-2017).4

Family History

Family History

Having a family history of prostate cancer increases the probability of developing prostate cancer.14

Initiate conversations with men about prostate cancer screening

Discuss

Discuss

Have you discussed PSA screening with your patients?

Identify

Identify

Have you identified any risk factors in your patients?

Decide

Decide

What is the next step for the patient?

Discuss screening. Identify risk factors.
Decide together on next steps.

  • Your actions could have a major impact for your patients with prostate cancer

References: 1. Grossman DC, Curry SJ, Owens DK, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA 2018;319(18):1901-13. Erratum in: JAMA 2018;319(23):2443. 2. American Urological Association. Early detection of prostate cancer: AUA guideline (06-2018). https://www.auanet.org/Documents/Guidelines/PDF/EarlyProstateCancerGuideline_71318%20PDF.pdf. Accessed 06-18-2020. 3. American Cancer Society. Cancer Facts & Figures 2020. Atlanta, GA: American Cancer Society; 2020. 4. National Cancer Institute. SEER cancer statistics review, 1975-2017 (04-2020). https://seer.cancer.gov/csr/1975_2017/results_merged/sect_23_prostate.pdf. Accessed 04-15-2020. 5. National Cancer Institute. Surveillance, epidemiology, and end results (SEER) (02-2018). https://seer.cancer.gov/about/factsheets/SEER_Overview.pdf. Accessed 01-21-2020. 6. National Cancer Institute. Cancer trends progress report: prostate cancer screening (03-2020). https://progressreport.cancer.gov/detection/prostate_cancer. Accessed 06-26-2020. 7. United States Census. Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin: April 1, 2010 to July 1, 2019 (CC-EST2019-ALLDATA) (06-2020). https://www.census.gov/data/tables/time-series/demo/popest/2010s-counties-detail.html. Accessed 09-17-2020. 8. Patel NH, Bloom J, Hillelsohn J, et al. Prostate cancer screening trends after United States Preventative Services Task Force guidelines in an underserved population. Health Equity 2018;2(1):55-61. 9. American Cancer Society. Key statistics for prostate cancer (01-08-2020). https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed 01-31-2020. 10. IQVIA Institute. Shifts in healthcare demand, delivery and care during the COVID-19 era (04-2020). https://www.iqvia.com/insights/the-iqvia-institute/covid-19/shifts-in-healthcare-demand-delivery-and-care-during-the-covid-19-era. Accessed 06-26-2020. 11. Shah N, Ioffe V, Huebner T, Hristova I. Prostate biopsy characteristics: a comparison between the pre- and post-2012 United States Preventive Services Task Force (USPSTF) prostate cancer screening guidelines. Rev Urol 2018;20(2):77-83. 12. Jemal A, Culp MB, Ma J, Islami F, Fedewa SA. Prostate cancer incidence 5 years after US Preventive Services Task Force recommendations against screening. J Natl Cancer Inst 2020 (Epub) 05-20-2020. 13. Kelly SP, Anderson WF, Rosenberg PS, Cook MB. Past, current, and future incidence rates and burden of metastatic prostate cancer in the United States. Eur Urol Focus 2018;4(1):121-7. 14. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Early Detection V.2.2020. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed 08-28-2020. To view the most recent and complete version of the guideline, go online to NCCN.org.