Impact on Prostate Cancer Clinical Presentation After Non-Screening Policies at a Tertiary-Care Medical Center.

Abstract BACKGROUND:In May 2012 the US Preventive Task Force (USPTF) issued a ‘D’ recommendation for routine PSA-based prostate cancer early detection. This recommendation was implemented progressively in our health system. The aim of this study is to define its impact at a tertiary care institution. METHODS:A retrospective analysis was performed from 2012 till 2015 at a single center. We analyzed the total number of biopsies performed per year and the positive biopsy rate. For those patients with positive biopsies we recorded diagnostic PSA, clinical stage, ISUP grade group, nodal involvement and metastatic status at diagnosis. RESULTS:A total of 1686 biopsies were analyzed. The positive biopsy rate (PBR) increased from 25% in 2012 to 40% in 2015 (p<0.05). No change in median PSA was noticed (p=0.627). Biopsies detected higher ISUP grades (p=0.000). In addition, newly diagnosed prostate cancer presented higher clinical stage (p=0.005), higher metastatic rates (p=0.03) and a tendency to higher lymph node involvement although not statistically significant (p=0.09).CONCLUSION:After the 2012 recommendation, patients presented higher probability of diagnosing prostate cancer, with more adverse ISUP group, clinical stage and metastatic disease. These results should be considered to implement a risk adapted strategy for prostate cancer screening.