Following the 2012 United States Preventative Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) screening in populations, rates of radical prostatectomy and biopsy have become significantly less common. Further revisions about prostate cancer-related recommendations should take a “panoramic view” to avoid unintended consequences, according to a recent article in JAMA Surgery.1
The results of the PLOC (Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial; ClinicalTrials.gov Identifier: NCT00002540) led the USPSTF to recommend against population-wide screening for prostate cancer, despite its widespread occurrence in the US.2
For the present study, researchers reviewed case logs from physicians who performed a prostate biopsy or radical prostatectomy between 2009 and 2016. Between 2009 and 2012, the average number of biopsies per urologist was 29; these figure decreased to 21 between 2013 and 2016. The decrease was much greater among male urologists than among females.
Median rate of radical prostatectomy per urologist decreased by only 1 during the same timeframe.
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The authors conclude that a “vantage point” is needed to accurately assess and predict the effects of USPSTF recommendations. Long term consequences may be broader than anticipated when guidelines are published; unintended consequences of previous revisions should therefore be taken into account when developing new recommendations.
- Halpern JA, Shoag JE, Artis AS, et al. National trends in prostate biopsy and radical prostatectomy volumes following the United States Preventative Services Task Force guidelines against prostate-specific antigen screening. JAMA Surg. 2016 Nov 2. doi: 10.1001/jamasurg.2016.3987 [Epub ahead of print]
- Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104(2):125–32. doi: 10.1093/jnci/djr500