Cutbacks in Screening Tied to Increase in Advanced Prostate Cancer Cases

Prostate Cancer Diagnoses Rise Amid Shifts in Screening Practices

A new study suggests that changes in prostate cancer screening guidelines more than a decade ago may have unintentionally led to later detection of the disease, which is the most common cancer among men. Recent data from the American Cancer Society shows that diagnoses are climbing, particularly at advanced stages, when treatment becomes far more difficult.

Shifts in Screening Guidelines

In 2012, the U.S. Preventive Services Task Force advised against routine screening using prostate-specific antigen (PSA) blood tests for healthy men. The goal was to reduce unnecessary treatments for cancers that might never become life-threatening. However, critics argue the decision relied too heavily on flawed research and overlooked evidence suggesting PSA testing saves lives.

By 2018, recommendations were updated, suggesting men aged 55 to 69 decide individually whether to screen, while men over 70 were advised against testing. With life expectancy rising, many doctors are questioning whether older men should still be excluded from screening altogether.

Concerns From Experts

Dr. Bill Dahut of the American Cancer Society noted that the pullback on PSA testing may have “swung the pendulum too far,” resulting in fewer cancers being caught early, when they are curable, and more being found at metastatic stages, when they are not. Other specialists echo this concern, pointing out that diagnoses of localized disease have dropped while advanced-stage cases continue to climb.

Trends in Cases and Mortality

From 2007 to 2014, prostate cancer diagnoses declined by about 6.4 percent each year. But starting in 2014, cases began to rise again, increasing by roughly 3 percent annually. Advanced cases, classified as “distant-stage disease,” have risen between 4.6 and 4.8 percent each year since 2017. Mortality rates, while still declining, have slowed significantly to less than 1 percent annually.

Prostate cancer remains the second leading cause of cancer death among men, with nearly 314,000 new cases and about 35,770 deaths expected in the U.S. this year.

Persistent Racial Disparities

The report also highlights racial inequalities. Black men are 67 percent more likely to develop prostate cancer than white men and are twice as likely to die from it. Native American men face higher mortality rates as well, despite a lower incidence of the disease. Studies within the Veterans Affairs health system, where access to care is equalized, show that Black men do not necessarily present with more aggressive cancers, suggesting that access to quality treatment is a key factor in disparities.

Screening Recommendations Today

The American Cancer Society currently advises men to discuss screening with their doctors at age 50, or earlier at 45 for Black men and those with a family history of prostate cancer. For men carrying the BRCA2 gene mutation, a PSA test as early as age 40 to 45 is recommended.

Reconsidering the Balance

Experts stress the importance of finding a middle ground between too much and too little screening. Over-testing can lead to overtreatment and serious side effects like impotence or incontinence, but scaling back too far risks missing aggressive cancers.

Dr. William K. Oh of Yale Cancer Center emphasized the need to re-examine current guidelines: “The reason death rates were going down was because we were finding prostate cancer earlier. My concern is that we abandoned a good strategy.”