{Reference Type}: Comparative Study
{Title}: US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses.
{Author}: Gejerman G;Ciccone P;Goldstein M;Lanteri V;Schlecker B;Sanzone J;Esposito M;Rome S;Ciccone M;Margolis E;Simon R;Guo Y;Pentakota SR;Sadeghi-Nejad H;
{Journal}: Investig Clin Urol
{Volume}: 58
{Issue}: 6
{Year}: 11 2017
{Factor}: 1.902
{DOI}: 10.4111/icu.2017.58.6.423
{Abstract}: To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted.<BR>We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score.<BR>A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p<0.0001). Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores. Patients were about 1 year younger in 2014 compared to 2011 (t-test; p=0.043). High Gleason scores (8-10) were diagnosed in 19% of the 2014 positive biopsies versus 9% in the 2011 positive biopsies (chi square; p<0.0001).<BR>After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates. We found a significantly higher incidence of high grade disease in 2014 compared with 2011. The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014. The higher incidence of these more aggressive cancers must be part of the discussion regarding PSA screening.