title: Impact of the United States Preventive Services Task Force 'D' recommendation on prostate cancer screening and staging.
abstract: OBJECTIVE
  In 2012, the United States Preventive Services Task Force (USPSTF) issued a grade 'D' recommendation against the use of routine prostate-specific antigen (PSA)-based screening for any men. This recommendation reflects critical misinterpretations of the available evidence base regarding benefits and harms of PSA screening and has influenced the nationwide landscape of prostate cancer screening, diagnosis, and treatment.
  
  
  RESULTS
  Following the USPSTF recommendation, a substantial decline in PSA screening was noted for all age groups. Similarly, overall rates of prostate biopsy and prostate cancer incidence have significantly decreased with a shift toward higher grade and stage disease upon diagnosis. Concurrently, the incidence of metastatic prostate cancer has significantly risen in the United States. These trends are concerning particularly for the younger men with occult high-grade disease who are expected to benefit the most from early detection and definitive prostate cancer treatment.
  
  
  CONCLUSIONS
  These emerging trends in PSA screening and prostate cancer incidence following the USPSTF recommendation may have significant public health implications. Due to the long natural history of the disease, a long-term follow-up is needed to provide a better understanding on the implications of such recommendations on disease progression and mortality rates in prostate cancer patients. The future of US screening policy should reflect a targeted 'smarter' screening strategy rather than dichotomizing the decision between 'screen all' or 'screen none'.
authors.affiliation: aDepartment of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA bDepartment of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany cDepartment of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Renu S
authors.initials: RS
authors.lastname: Eapen
authors.forename: Annika
authors.initials: A
authors.lastname: Herlemann
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Washington
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D026683:Advisory Committees; D014408:Biomarkers, Tumor / Q000097:blood; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data / Q000639:trends*; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D014481:United States
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen