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A person's gloved hand holds a blood sample used for PSA testing in front of a bar graph.

Study Finds High Rates of Metastatic Prostate Cancer Linked to Fewer PSA Screenings

Prostate cancer is the second most commonly diagnosed cancer in men worldwide. However, without screening, many men do not know that they have prostate cancer because they do not have symptoms. Doctors screen for prostate cancer by looking for a substance called prostate-specific antigen (PSA) in the blood.1

In 2012, experts changed PSA screening guidelines so men were screened less often. New research released in February 2021 showed that cases of metastatic prostate cancer increased over the past 10 years. Metastatic cancer is cancer that has spread from where it started to other places in the body. Screening rates also decreased during this time. Researchers now believe that the increase in cases is related to less screening.2

What is PSA?

PSA is a protein that is made by cells in the prostate. People living with benign (not cancerous) prostatic hyperplasia (BPH) often have slightly elevated levels of PSA in their blood. People living with prostate cancer also have elevated levels of PSA. That elevation may be mild like in BPH, or it may be significant.3

Because increases in PSA levels can be unclear, it is possible that prostate cancer can be over-diagnosed. Many men never experience any symptoms. Diagnosis in someone without any symptoms can be very helpful since it can prevent prostate cancer from getting worse. However, PSA tests may produce false-positive results. For these men, being diagnosed may lead to unneeded procedures and medicines.1

How were the screening guidelines changed?

The U.S. Preventative Services Task Force (USPSTF) is an organization that studies disease rates to create guidelines for healthcare. In 2008, the task force found that increased PSA screening led to unnecessarily increased diagnosis and treatment of prostate cancer. Because of this, the task force released guidelines in 2008 and 2012 that recommended against PSA screening.2

However, cases of advanced prostate cancer rose during that time, so the USPSTF updated its guidelines in 2016. The task force then recommended that men between 55 and 69 speak to their doctor about their prostate cancer risk. That way, men and their doctors can work together to make a decision about PSA screening that is right for them.4

What did the new research find?

The study examined whether there was a direct link between fewer PSA screenings and increased cases of advanced prostate cancer over the past 10 years. Researchers looked at data across the United States to see how screening rates and prostate cancer rates changed over time and between states.2

They found that not only did advanced prostate cancer rates rise as screening fell, but different states also had different results. The states that performed the least number of screenings saw the most cases of advanced prostate cancer.4

What comes next?

Overall, researchers found that reduced screening increases the risk of missing serious cases of prostate cancer. However, increased screening may lead to unnecessary procedures and medicines for less severe cases of prostate cancer. Researchers now say it is important for men to discuss risks and benefits of prostate cancer and screening with their doctor to choose what is right for them.4

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