End in sight?
There has been a decline in the proportion of men undergoing PSA tests in the US in recent years, the study authors point out.
Routine PSA testing rates among men aged 50 and older declined from 40.6% in 2008 to 38.3% in 2010, and dropped to 31.5% in 2013, a percentage which held again in 2015, per national self-reported survey data.
The study authors say the cause of the rise in advanced cancers is uncertain because of the descriptive nature of their research.
But Andrew Vickers, PhD, a biostatistician at the Memorial Sloan Kettering Cancer Center in New York City, said the rise in advanced cancers and the drop in early-stage cancers reported in the study are “suggestive of a causal relationship” and a “screening effect.”
Vickers argues that there were “a whole bunch of trends that came together in the late [2000s] to influence [PSA] screening.”
For example, two landmark randomized clinical trials of PSA screening first reported “unfavorable” results in 2009, which is during the period covered in the current study, and dampened enthusiasm for screening.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial reported little or no effect on mortality, the primary outcome of the trials.