Striking the Right Balance With Prostate Cancer Screening
Menée à partir des données des registres américains des cancers portant sur 836 282 patients atteint d'un cancer métastatique de la prostate diagnostiqué entre 2004 et 2018 (âge : 45-74 ans), cette étude analyse l'évolution de l'incidence de la maladie, avant et après l'implémentation des recommandations de l'"US Preventive Services Task Force" concernant le dépistage par dosage du PSA dès l'âge de 45 ans
Desai and colleagues, analyzing Surveillance, Epidemiology, and End Results data from 2004 through 2018, found significantly increasing incidence rates of metastatic prostate cancer (mPCa) among men aged 45 to 74 years (during the period 2010-2018) and among men ages 75 and older (during the period 2011-2018). In the earlier periods, incidence rates of mPCa disease were stable in younger men and decreasing in older men. The authors highlighted the temporal association between the mPCa incidence trends and preceding US Preventive Services Task Force (USPSTF) recommendations.In 2008, the USPSTF recommended against any screening of men aged 75 years and older (grade D), but concluded that evidence was insufficient to make recommendations for younger men (grade I). PCa incidence rates subsequently began declining, most notably in older men. In the fall of 2011, the USPSTF issued a draft recommendation against PCa screening for men of all ages. This grade D recommendation was based on evidence that the PCa mortality benefits of screening were small to none and that screening resulted in harms related to false-positives, biopsy and treatment complications, overdiagnosis, and overtreatment. The final recommendation, published in the spring of 2012, remained a grade D. The draft USPSTF recommendation was clearly influential, being associated with an astounding reduction in PCa incidence. Jemal and colleagues estimated that 33 519 fewer US PCas were diagnosed in 2012 compared with 2011. Those authors also presented results from the National Health Interview Surveys showing decreasing PCa screening rates from 2008 to 2013. These findings strongly suggest an association between declining incidence rates and the USPSTF recommendations on screening practices.
JAMA Network Open , commentaire, 2021