USPSTF Recommendation Against PSA Screening vs. Stage and Cancer‐Specific Mortality in Localized Prostate Cancer

ABSTRACT Background The USPSTF recommendation against PSA screening (RAPS) in 2012 resulted in unfavorable changes in prostate cancer (PCa) outcomes. However, the effect on cancer‐specific mortality (CSM) in localized PCa has not been assessed. Methods Within the Surveillance, Epidemiology, and End Results database (2004–2021), we identified patients treated with radiotherapy (RT) or radical prostatectomy (RP) for localized PCa. Time trends were examined using least‐squares linear regression. Multivariable Cox regression was used to study the association between RAPS and PCa‐mortality. Results Of 270,092 patients aged < 75 years, 191,621 (70.1%) were treated before and 78,471 (29.1%) in the RAPS era. CSM at 6 years of follow‐up was 1.6% (95% confidence interval [CI]: 1.6, 1.7) before and 1.9% (95%CI: 1.8, 2.0) in the RAPS era ( p < 0.001). In multivariable Cox models adjusted to patient characteristics, RAPS era independently predicted 1.2‐fold higher CSM overall (95%CI: 1.1, 1.3; p < 0.001), 1.3‐fold higher CSM in RP‐patients (95%CI: 1.1, 1.4; p < 0.001), and 1.1‐fold higher CSM in RT‐patients (95%CI: 1.02, 1.2; p = 0.02) aged < 75 years. Of 33,688 patients aged ≥ 75 years, 12,485 (37.1%) were treated before and 21,203 (62.9%) in the RAPS era. CSM at 6 years of follow‐up was 4.2% (95%CI: 3.8, 4.6) before and 4.8% (95%CI: 4.5, 5.1) in the RAPS era ( p = 0.002). In multivariable Cox models adjusted to patient characteristics, RAPS era did not predict higher CSM overall, in RP‐patients, or in RT‐patients (all p ≥ 0.5) aged ≥ 75 years. Limitations include changes in early detection and disease management over time, which might have impacted CSM as well. Conclusions The USPSTF RAPS introduction resulted in a 1.2‐fold higher CSM in localized PCa patients aged < 75 years, but not in patients aged ≥ 75 years. The time trend analysis suggested that this negative effect has become increasingly pronounced since the USPSTF RAPS.