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Introduction:
Prostate cancer is the second leading cause of cancer death in men in the US. Recently, the USPSTF gave PSA screening for prostate cancer a grade “D”, recommending against its use. We aim to study the effects of that recommendation on our patients to determine if this led to patient reticence in seeking treatment, and consequently, more aggressive disease at the time of surgery.
Methods:
We retrospectively reviewed charts of 1220 patients who underwent a robotic-assisted prostatectomy by a single surgeon at Washington Hospital Center from 10/2006-08/2014. Patients were divided into pre- and post- USPSTF recommendation according to date of surgery, and were compared by Age, Race, PSA level at surgery, Clinical stage (T2c and below vs. T3 and greater), Pre-operative digital rectal exam (DRE) findings, margin status, and Gleason Score (7 or less vs. 8 or greater). We used Fisher’s exact test and t-test for statistical analysis.
Results:
95 patients were excluded due to missing data points, leaving 1125 included for analysis. The results are summarized in this table

	Pre-USPSTF recommendations	Post-USPSTF recommendations	P-value
Total number	820	305
Mean age	61.2461	62.0269
Gleason Score (8 or greater)	51/820 (6.22%)	23/305 (7.54%)	0.4195
Positive Surgical Margins	167/820 (20.37%)	78/305 (25.57%)	0.1060
T stage ≥ 3	123/820 (15.00%)	76/305 (24.91%)	0.0002
Abnormal DRE	204/820 (24.88%)	71/305 (23.28%)	0.6397
Mean PSA	6.5413	8.1809	<0.0001

Conclusions:
We are seeing a trend towards higher cancer stage and higher PSA at the time of prostate cancer diagnosis as early as 27 months following the USPSTF recommendations. These findings are concerning for a trend toward a pre-PSA era, higher stage prostate cancers at the time of intervention, and overall worse patient outcomes.