Metastatic Prostate Cancer Surges: Could Reduced PSA Screening Be A Cause? Interview with:

Dr. Adam Weiner MD Urology Resident Feinberg School of Medicine Northwestern University

Dr. Adam Weiner

Dr. Adam Weiner MD
Urology Resident
Feinberg School of Medicine
Northwestern University What is the background for this study? 

Response: There has been a lot of controversy over the past decade regarding whether PSA screening for prostate cancer prevents death from prostate cancer. Accordingly, the US preventive services task force (USPSTF) recommended against PSA screening for older men in 2008 and for all men in 2012. This was mainly based on information from a large clinical trial in the US.

Recently it was discovered that men in the non-screening part of this trial received even more PSA screens than men in the screening part of the trial, suggesting the results were likely diluted.

In a large European trial, PSA screening was shown to reduce both death from prostate cancer and the number of men diagnosed with metastatic prostate cancer, an incurable and deadly form of prostate cancer.  What are the main findings?

Response: Our study looked at over 1000 hospitals in the US from 2004 and 2013. We found that over that time period, the number of men who presented with metastatic prostate cancer at diagnosis increased by 72%. This may be due to a number of reasons including changes in the number of men who are being screened for prostate cancer, improvements in how we detect metastases, and prostate cancer may becoming more aggressive. What should readers take away from your report?

Response: Prostate cancer is a highly treatable disease when it is discovered before it has metastasized. In the metastatic form, it’s often incurable and much more deadly. Additionally the side-effects of treatment and the pain associated metastases to the bone can often be difficult for patients.

Although it is impossible to say our study links the rise in metastatic prostate cancer to changes in screening, it does support the need for better screening practices. We need to learn who needs screening the most and how often screens should be offered in order to best prevent overdiagnosing patients who don’t need treatment and missing catching prostate cancer in a treatable form. What recommendations do you have for future research as a result of this study?

Response: Future studies should confirm our findings in other databases. Our study was unable to look at the incidence of metastatic prostate cancer a rate per 100,000 people. It did, however, show a large increase in the number of men presenting with metastatic prostate cancer in a large group of hospitals throughout the country.

Additionally, it is paramount that we determine the best way to screen for prostate cancer. We should focus our screening efforts on men most likely to die from prostate cancer and that begins with an adjustment in screening guidelines recognizes many men likely do benefit from screening. Thank you for your contribution to the community.


Weiner, A.B., Schaeffer, E.M. et al. Increasing incidence of metastatic prostate cancer in the United States. Prostate Cancer and Prostatic Diseases, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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