{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T17:32:44Z","timestamp":1781976764934,"version":"3.54.5"},"reference-count":19,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The USPSTF recommendation against PSA screening (RAPS) in 2012 resulted in unfavorable changes in prostate cancer (PCa) outcomes. However, the effect on cancer\u2010specific mortality (CSM) in localized PCa has not been assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Within the Surveillance, Epidemiology, and End Results database (2004\u20132021), we identified patients treated with radiotherapy (RT) or radical prostatectomy (RP) for localized PCa. Time trends were examined using least\u2010squares linear regression. Multivariable Cox regression was used to study the association between RAPS and PCa\u2010mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 270,092 patients aged &lt;\u200975 years, 191,621 (70.1%) were treated before and 78,471 (29.1%) in the RAPS era. CSM at 6 years of follow\u2010up was 1.6% (95% confidence interval [CI]: 1.6, 1.7) before and 1.9% (95%CI: 1.8, 2.0) in the RAPS era (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable Cox models adjusted to patient characteristics, RAPS era independently predicted 1.2\u2010fold higher CSM overall (95%CI: 1.1, 1.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), 1.3\u2010fold higher CSM in RP\u2010patients (95%CI: 1.1, 1.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and 1.1\u2010fold higher CSM in RT\u2010patients (95%CI: 1.02, 1.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) aged &lt; 75 years. Of 33,688 patients aged \u2265\u200975 years, 12,485 (37.1%) were treated before and 21,203 (62.9%) in the RAPS era. CSM at 6 years of follow\u2010up was 4.2% (95%CI: 3.8, 4.6) before and 4.8% (95%CI: 4.5, 5.1) in the RAPS era (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). In multivariable Cox models adjusted to patient characteristics, RAPS era did not predict higher CSM overall, in RP\u2010patients, or in RT\u2010patients (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2265\u20090.5) aged \u2265 75 years. Limitations include changes in early detection and disease management over time, which might have impacted CSM as well.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The USPSTF RAPS introduction resulted in a 1.2\u2010fold higher CSM in localized PCa patients aged &lt;\u200975 years, but not in patients aged \u2265\u200975 years. The time trend analysis suggested that this negative effect has become increasingly pronounced since the USPSTF RAPS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70045","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:35:23Z","timestamp":1757482523000},"page":"1531-1540","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["USPSTF Recommendation Against PSA Screening vs. Stage and Cancer\u2010Specific Mortality in Localized Prostate Cancer"],"prefix":"10.1002","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-3982","authenticated-orcid":false,"given":"Fabian","family":"Falkenbach","sequence":"first","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Martini\u2010Klinik Prostate Cancer Center University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Bello","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Neurosciences, Science of Reproduction and Odontostomatology University of Naples Federico II Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natali Rodriguez","family":"Pe\u00f1aranda","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Longoni","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marmiroli","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Urology IEO European Institute of Oncology IRCCS Milan Italy"},{"name":"Universit\u00e0 Degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh Chi","family":"Le","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Urology, Frankfurt am Main Goethe University Frankfurt, University Hospital  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Tian","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4609-8981","authenticated-orcid":false,"given":"Jordan A.","family":"Goyal","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Science of Reproduction and Odontostomatology University of Naples Federico II Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Micali","sequence":"additional","affiliation":[{"name":"Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Briganti","sequence":"additional","affiliation":[{"name":"Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ottavio","family":"De Cobelli","sequence":"additional","affiliation":[{"name":"Department of Urology IEO European Institute of Oncology IRCCS Milan Italy"},{"name":"Universit\u00e0 Degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix K. H.","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Urology, Frankfurt am Main Goethe University Frankfurt, University Hospital  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Saad","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrokh F.","family":"Shariat","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna Vienna Austria"},{"name":"Department of Urology Weill Cornell Medical College New York New York USA"},{"name":"Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA"},{"name":"Hourani Center for Applied Scientific Research Al\u2010Ahliyya Amman University Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bud\u00e4us","sequence":"additional","affiliation":[{"name":"Martini\u2010Klinik Prostate Cancer Center University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"Department of Urology University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Graefen","sequence":"additional","affiliation":[{"name":"Martini\u2010Klinik Prostate Cancer Center University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre I.","family":"Karakiewicz","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology University of Montr\u00e9al Health Center Montr\u00e9al Qu\u00e9bec 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