Determining PSA Screening Recommendation Penetration

The controversy regarding the impact of prostate-specific antigen (PSA) testing on outcomes for men diagnosed with cancer has intensified since the 2008 US Preventive Services Task Force recommendation against regular PSA testing for men 75 years or older. This has been compounded by a wider preliminary and then final (grade D) recommendation against regular PSA screening for all men. In this issue of JAMA Oncology, Hu et al report that when analyzing the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013, there may be an increase in the proportion of distant metastatic disease in older men after 2011. An earlier publication in this journal by Jemal et al suggested that distance metastatic disease has not appreciably changed over the period 2012 to 2013. It is possible that these seemingly contradictory results are simply a statistical random variation of incidence that can change over time depending on the frequency of measurement as well as the variation in staging definition. In the case of these 2 articles, while both analyze SEER data, Summary Staging (from the SEER Summary Staging Manual – 2000: Codes and Coding Instructions) was used by Jemal et al, while the current article by Hu et al used Collaborative Staging (from the SEER Training Modules; http://ift.tt/2iuDk9C). The impact on mortality from screening is not well defined. Hence, clinicians will need to be cautious in their interpretation of the screening as well treatment guidelines for the individual patient in front of them.

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