8 per 100,000 in 2019. Comparing health centers, the researchers found, those that maintained higher screening rates had fewer advanced cancer cases: For every 10% increase in the screening rate, the incidence of metastatic cancer dipped by 9%.
Experts not involved in the study were divided on whether that information is useful to individual men.
Dr. Anthony Corcoran, who directs urologic oncology at NYU Langone Hospital – Long Island, says it is.
In 2018, the USPSTF again updated its recommendations, saying that for 55- to 69-year-old men, the decision on whether to have PSA screening should be individualized — after a discussion of the pros and cons with their doctor.
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Corcoran says the new findings are another piece of evidence that screening lessens the chances of being diagnosed with metastatic cancer. But, he says, that still has to be balanced against the downsides of screening for any one man.
Age alone should not be the deciding factor, Corcoran shares. A 70-year-old in good health could have many years of life ahead and benefit from PSA screening; a 70-year-old in poor health may not.
“The decision to screen should be based on a patient’s overall health and what they value,” Corcoran adds.
Dr. Robert Dreicer, deputy director of the University of Virginia Cancer Center in Charlottesville, did not consider the findings useful for individual decision-making.
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“The data here are interesting and provocative,” says Dreicer, who is also an expert with the American Society of Clinical Oncology. But, he adds, they only show a relationship between facility-level PSA screening rates and metastatic cancer cases — which is not proof that screening will protect men from developing advanced cancer.
However, all three doctors agreed that those one-on-one discussions are key to making screening decisions.
Dreicer says it’s important for men to understand their baseline risk of prostate cancer, since those at increased risk stand to benefit more from screening.
That group includes Black men and men with a father or brother who developed prostate cancer before age 65. If you fall under this group, the American Cancer Society recommends that you talk with your doctor about PSA screening starting at age 45. That discussion should take place sooner — age 40 — if you have more than one first-degree relative who developed prostate cancer at an early age.
