Less prostate cancer screening reduces overdiagnosis but may miss aggressive cases (More high-grade cancers now found than low grade - 1st time ever - showing PSA diagnosis delays kill)

Medical Xpress / Weill Cornell Medical College / JNCI: Journal of the National Cancer Institute ^ | Apr. 22, 2022 | Leonardo D Borregales et al

[ConservativeMind]

Over the past 15 years, public health authorities have downgraded recommendations for the prostate-specific antigen (PSA) test as a screening tool to reduce the overdiagnosis and overtreatment of men with low-grade prostate cancer. Now, researchers have found that while these efforts have been effective, the incidence of higher-grade disease and metastasis at diagnosis have risen.

"To our knowledge, this is the first study to demonstrate nationally that low-grade prostate cancer is no longer the most commonly diagnosed type of prostate cancer," said Dr. Jim Hu.

In 2012, the U.S. Preventative Services Task Force (USPSTF) recommended against screening all men with the PSA test, concluding that the benefits of the test, which measures levels of a protein often overproduced in prostate cancer cells, did not outweigh the risks. Then in 2018, the USPSTF issued a revision to include shared decision making for the PSA test for men aged 55 to 69 years, reflecting emerging evidence of longer-term benefits and widespread adoption of active surveillance after detection of low-risk disease.

The analysis revealed a significant decrease in the incidence of the lowest-risk prostate cancer, Gleason Grade 1 (GG1), falling from 52 to 26 cases per 100,000 men across all age groups. Further, the proportion of GG1 found on pathology in men who had a radical prostatectomy decreased from 32 to 10 percent. However, metastases rates at diagnosis increased from 3.0 percent to 5.2 percent over the same period. Halting PSA testing appeared to be the primary driver of these trends.

Public health authorities should consider implementing risk-stratified screening, such as MRI or biomarkers, continuing to minimize overdiagnosis and avoid biopsy in men with low-risk prostate cancer while addressing the rising trends of high-grade and metastatic prostate cancer, the authors concluded.

[ConservativeMind]

Here is some support for what I said:

Lycopene and Risk of Prostate Cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616444/

Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders

https://www.frontiersin.org/articles/10.3389/fonc.2020.01293/full#B69

Why Zinc Picolinate May Be the Best of All Zinc Supplements

https://www.livestrong.com/article/471892-what-is-zinc-picolinate/