Background: The United States Preventative Services Task Force (USPSTF) guideline on Prostate Specific Antigen (PSA)-based prostate cancer screening evolved both in 2008 (Grade I for men < 75 years and Grade D for men > 75 years) and in 2012 (Grade D for all ages). Materials and methods: A statewide cancer registry operated by the Pennsylvania Department of Health was accessed to analyze over a 15-year period prostate cancer rates across different categories including age, stage, and geographic distribution. Results: Local prostate cancer rates decreased significantly when comparing before and after USPSTF's guideline changes: 2002–2008 vs. 2009–2012 vs. 2013–2016 (p < 0.005). Conversely, the distant cancer rates increased significantly in Caucasian men (but not in African American men) (p = 0.0078). In age group analysis, distant cancer rates increased significantly in all age ranges, most notably in younger men (50–59 years). No observed difference in the trend of distant cancer rates when considering rural versus urban counties. Conclusions: Incident prostate cancer cases diagnosed in Pennsylvania have decreased over the past 15 years with a recent rise in distant carcinomas potentially attributable to the USPSTF recommendations against PSA-based screening. Although the USPSTF revised their PSA-based prostate cancer screening guideline in 2018 (Grade C for men 55–69 years and Grade D for men > 70 years), the implications of the aforementioned observations on mortality outcomes merit further follow-up.
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