A new study has revealed declines in prostate cancer screening and diagnoses in the United States in recent years, as well as decreases in the use of definitive treatments among men who have been diagnosed.1

Over the past decade, there has been considerable debate surrounding the value of prostate cancer screening performed by means of prostate-specific antigen (PSA) testing, and the 2012 recommendation of the United States Preventive Services Task Force (USPSTF) against PSA testing lies at the center of the debate. The USPSTF recommendation was made in part due to the potential harms—such as erectile dysfunction and urinary incontinence—associated with the treatment of clinically insignificant prostate cancer with radical prostatectomy or radiation.

To examine the use of diagnostics and treatments for prostate cancer in the years surrounding the USPSTF recommendation, James Kearns, MD, of the University of Washington School of Medicine, and his colleagues analyzed MarketScan claims data from privately insured patients in the United States.

The team looked specifically at information related to PSA testing, prostate biopsy, prostate cancer diagnosis, and definitive local treatment among men aged 40 to 64 years, for the years 2008–2014. Men under age 65 may benefit most from radiation or surgery for their prostate cancer because prostate cancer tends to cause problems for men many years after diagnosis.1

In the analysis of approximately 6 million men with a full year of data, PSA testing, prostate biopsy, and prostate cancer detection declined significantly between 2009 and 2014, most notably after 2011. Over the study period, the prostate biopsy rate for patients with a PSA test decreased from 1.95 to 1.52 per 100 patients.

However, prostate cancer incidence per prostate biopsy increased over the study period from 0.36 to 0.39. Among patients with new prostate cancer diagnoses, the proportion managed with definitive local treatment decreased from 69% to 54%. Both PSA testing and prostate cancer incidence decreased significantly after 2011.1

“In addition to finding decreased prostate cancer screening, we found that fewer men were being diagnosed with prostate cancer, and even fewer men were being treated with surgery or radiation for their prostate cancer,” says Kearns. “This means that they are likely choosing active surveillance for low-risk prostate cancer.

“This is important because active surveillance has been shown to be safe in many men, and it avoids problems associated with prostate cancer treatment, such as urinary incontinence and erectile dysfunction,” Kearns adds.

“Part of the controversy surrounding prostate cancer screening was that men who didn’t need surgery or radiation for their prostate cancer were still undergoing those treatments,” says Kearns. “If those men are instead undergoing active surveillance of their low-risk prostate cancer, then the harms of screening will be lower.”

In an editorial accompanying the study, Christopher Filson, MD, MS, of Emory University School of Medicine observes that additional research is needed to determine which men will gain the most value from screening, and to identify and correct gaps in the delivery of prostate cancer care, while also minimizing overtreatment and reducing the future incidence of metastatic prostate cancer. “The key will be performing PSA screening—in addition to biopsies and prostate cancer treatment—more intelligently, not more frequently,” he writes.2 


  1. Kearns J, Holt S, Wright J, et al. PSA screening, prostate biopsy, and treatment of prostate cancer in the years surrounding the USPSTF recommendation against prostate cancer screening. Cancer. Published online first, May 21, 2018; doi: 10.1002/cncr.31337
  2. Filson, C. Moving toward a more rational, evidence-based approach to PSA screening, diagnosis, and treatment of prostate cancer. Cancer. Published online first, May 21, 2018; doi: 10.1002/cncr.31332.