A major shift in prostate cancer screening policy may have unintentionally deepened health disparities, particularly among minority communities. In 2012, the US Preventive Services Task Force (USPSTF) downgraded routine PSA screening to a grade D, aiming to reduce overdiagnosis and overtreatment. However, new findings presented at the American Urological Association meeting suggest the change led to more advanced disease at diagnosis and poorer surgical outcomes.
Dr. Minh Nguyen of the University of North Carolina reported that men diagnosed after the screening downgrade had significantly worse pathology. A retrospective analysis of over 560,000 men who underwent prostatectomy revealed increased odds of positive surgical margins and lymph node metastasis. The likelihood of being diagnosed with high-grade disease (Gleason 8 or higher) also rose.
The data showed a clear shift toward more advanced disease at diagnosis, with a 23% higher relative risk of metastatic cancer compared to earlier-stage cases. Most concerning, men in the post-2012 cohort faced a 15% higher mortality risk following surgery.
These findings raise critical concerns for Black and Hispanic men, who already face higher prostate cancer mortality rates. Delayed detection due to reduced screening may disproportionately affect these groups, compounding existing disparities.
Dr. Nguyen’s team emphasized the need for more nuanced, risk-adapted screening strategies. “These trends reflect an increase in management of higher risk prostate cancer and raise the question as to the possible continued lasting negative impact of not recommending PSA screening for age-appropriate men.”
See “USPSTF 2012 PSA Screening Change Led to Worse Prostate Cancer Surgical Outcomes” (May 19, 2025)
