Screening for early cancer detection may reduce the rate of related metastatic disease, but not always.

In a published study in the New England Journal of Medicine, researchers evaluated the incidence of men having a diagnosis of advanced, metastatic prostate cancer at the initial prostate cancer diagnosis. The researchers data from the Surveillance, Epidemiology, and End Results (SEER) Program database. Their analysis included only those men who had been diagnosed with advanced prostate cancer at diagnosis, not of early-stage disease that then progressed to metastasis.

In this perspective study the authors describe trends in metastatic prostate cancer prior to and more than a decade after the widespread use of the prostate-specific antigen (PSA) test.   They found that the incidence of initial diagnoses of metastatic prostate cancer fell by approximately 50% within 7 years of the start of the widespread use of PSA tests in 1990.

One of the researchers, Dr Welch said that “the rapid uptake of PSA screening in the United States led to a dramatic spike in overall prostate cancer diagnoses during the early 1990.”

In their discussion of their findings, the study authors postulated that the many interventions we have made to reduce prostate cancer risk as well as the reductions in environmental carcinogens might contribute to a reduction in the incidence of prostate cancer, but they believe that “it’s hard to imagine another factor

[other than PSA screening] changing and exerting an effect so quickly.”

Prostate cancer expert Anthony V. D’Amico, MD, PhD, who was not involved with the new essay, agreed with this conclusion. “The initial spike in all prostate cancer incidence