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The study using National Cancer Database data reveals a sustained increase in the proportion of advanced prostate cancer (PCa) at diagnosis from 2010 to 2020, accelerated by the COVID-19 outbreak, while the 2018 USPSTF recommendations on PCa screening seem to have had a limited impact.

The following is a summary of “Clinical stage and grade migration of localized prostate cancer at diagnosis during the past decade,” published in the December 2023  issue of Urology by Beatrice, et al.

Early 2010s data showed a change in stage and grade toward more advanced prostate cancer (PCa) at detection. This was sped up by the US Preventive Services Task Force’s 2012 advice against PSA screening.

For a study, researchers used the National Cancer Database to look into how the 2018 USPSTF proposal and the COVID-19 spread affected this change. They hypothesized the COVID-19 breakout would add to the stage-and-grade movement toward more dangerous diseases. They identified mens who were diagnosed with localized PCa between 2010 and 2020. They looked at how the percentage of PCa categorized by D’Amico risk changed over time. They used multivariable logistic regression models to look at the link between the year of diagnosis and binary factors that showed the stage and grade of the PCa. Marginal effect studies determined the predicted probabilities and their 95% CI.

They found 910,898 men with PCa, which was limited. From 34.9% in 2010 to 17.7% in 2020, the share of low-risk PCa dropped by almost half (P < 0.001). Each year, the odds of having PSA levels higher than 10 ng/dL increased compared to 2010. The odds of having cT3–T4 went up compared to 2015 (aOR2015 1.10; 95% CI, 1.03–1.17), ISUP GG 3–5 went up compared to 2011 (aOR2011 1.06; 95% CI, 1.03–1.08), and finally, the odds of being in the D’Amico intermediate/high-risk class went up compared to 2010. Over time, there were changes in the odds of having PSA levels of 10 ng/dL or higher and cT3–T4 levels at diagnosis (all P < 0.001). The highest chance of having PSA levels above 10 ng/dL was 29.0% (95% CI: 28.0%–29.0%) in 2018. The highest chance of cT3–T4 was 3.7% (95% CI: 3.6%–3.8%) 2020. There was a steady rise in all the other outcome factors (all P < 0.001), with the best chances for ISUP GG 3–5 (42.3%, 95% CI, 41.9%–42.6%) and D’Amico intermediate/high-risk (81.3%, 95% CI, 81.0%–81.6%) in 2020.

The study showed that there has been a long-lasting shift toward a higher percentage of severe PCa at diagnosis. The COVID-19 outbreak most likely caused this change. The 2018 USPSTF PCa screening proposal does not affect the number of severe PCa cases, possibly because of the pandemic. In the years after the pandemic, more research should be done to see the long-term effects of the 2018 USPSTF suggestions.

Source: sciencedirect.com/science/article/abs/pii/S1078143923003265