Sustained PSA screening is associated with downstaging and improved survival in prostate cancer: a 12-year Korean cohort study

Abstract

Objectives To evaluate the impact of prostate-specific antigen (PSA) screening on prostate cancer (PCa) characteristics and survival outcomes in a contemporary cohort, amidst evolving PSA screening practices.

Methods We retrospectively analyzed clinicopathologic data of 5,437 men diagnosed with PCa via prostate biopsy at our institution between 2006 and 2018. Patients were categorized as PSA-detected (PCa detected by PSA testing in asymptomatic individuals) or Symptom-detected (PCa detected after PSA testing prompted by symptoms). Temporal trends in PSA screening and cancer characteristics were assessed using correlation and time-series analyses. Multivariable Cox regression evaluated the effect of PSA screening on overall and cancer-specific survival.

Results The PSA screening rate in our cohort increased from 46.4% in 2006 to 63.1% in 2018 (p < 0.001). Greater PSA screening uptake was associated with an increasing proportion of Gleason score 7 tumors (r = 0.608, p = 0.028), more localized-stage disease (r = 0.757, p = 0.003), and fewer cases of distant metastasis at diagnosis (r = -0.605, p = 0.028). The detection of clinically insignificant (low-risk) cancer rose modestly over time (r = 0.437, p = 0.136) but was not significantly influenced by PSA screening rates (r = 0.496, p = 0.085). On multivariate analysis, PSA screening was an independent predictor of improved overall survival (hazard ratio [HR] 0.54, p < 0.001) and cancer-specific survival (HR 0.46, p < 0.001).

Conclusions Increasing utilization of PSA screening correlated with a stage migration toward localized disease and a reduction in metastatic presentations, without a substantial increase in the detection of clinically insignificant cancer, as defined by Epstein criteria. PSA screening was an independent prognostic factor for better survival outcomes.