Trends in prostate cancer mortality after the 2012 USPSTF PSA guideline: Comparisons with kidney cancer and racial disparities.

Abstract

325 Background: In 2012, the USPSTF issued a Grade D recommendation against PSA-based screening for prostate cancer. While intended to reduce overdiagnosis, the change raised concerns about unintended effects on mortality. We evaluated national mortality trends to determine whether prostate cancer mortality declines stalled post-2012 and whether patterns diverged from kidney cancer, a comparator unaffected by PSA screening. Methods: Mortality data for U.S. men aged 45–85 years (1999–2020) were obtained from CDC WONDER. Prostate cancer deaths (ICD-10 C61) and kidney cancer deaths (C64–C65) were analyzed. Age-adjusted mortality rates (per 100,000) were stratified by race/ethnicity and age (50–69, the screening-eligible group, vs ≥70). Joinpoint regression estimated APC with 95% CIs; interrupted time-series models assessed slope changes. Results: Prostate cancer mortality declined significantly from 1999 - 2014 (APC - 3.51%, 95% CI - 3.61 to - 3.43). After the 2012 USPSTF recommendation, declines slowed: mortality plateaued in 2014–2018 (APC –0.69%, 95% CI - 1.15 to 0.00) and then increased in 2018 - 2020 (APC +2.63%, 95% CI - 1.12 to +7.06). This lag is consistent with delayed effects of reduced screening. Kidney cancer mortality showed no 2012-specific inflection, declining overall (2001 - 2015 APC - 0.74%, 95% CI - 0.76 to - 0.59) with a steeper drop in 2015 - 2018 and only a modest, nonsignificant uptick in 2018 - 2020, supporting its role as a negative control. Decline attenuation was most marked in men aged 50 - 69, while ≥70 showed little change. Black men had the highest absolute mortality and the most pronounced stall. Conclusions: The 2012 USPSTF Grade D PSA screening recommendation was temporally associated with a stall in previously steady prostate cancer mortality declines, particularly among Black men and those aged 50–69, whereas kidney cancer mortality continued to decline without similar interruption. This comparative, negative-control framework highlights how screening policies may inadvertently slow progress and widen disparities. Findings emphasize equity-focused, age-specific approaches in future screening guidelines and careful balancing of overdiagnosis concerns against risks of stalled mortality progress. Limitations include lack of individual-level data and heterogeneous policy implementation. Further studies are needed to validate mechanisms underlying these disparities.