Introduction: The United States Preventative Services Task Force (USPSTF) issued a grade “D” recommendation against PSA-based prostate cancer (PCa) screening in 2012. We present an analysis of a prospectively collected data repository including PCa tumor burden, Gleason score group, PSA and prostate biopsy positivity rates in a community setting a decade since the Task Force recommendation Methods: We identified 7,914 patients undergoing prostate biopsy between April 2011 and December 2021 from the Genesis Healthcare Partner’s (large urology group practice) electronic medical record (EMR). For 2011, we annualized the number of biopsies performed based on an imputed estimate from April through December of 2011. We compiled the number of prostate biopsies and proportions of biopsies demonstrating cancer, Gleason score (6, 7, 8-10), and the maximum positive biopsy core percentage involvement with cancer. Statistical analysis included Chi Square and a one-way ANOVA. Results: The annual biopsy rate was significantly higher in 2011 (997 cases [748 actual cases plus 249 estimated cases] than for all other years. Chi Square analysis indicated a significant consistent increase (p < 0.001) in the percentage of positive biopsies between 2011 (44.25%) and 2021 (65.91%). The proportion of low grade disease significantly decreased (p < 0.001) between 2011 and 2021 from 49.12% to 33.33%, while the proportion high grade disease significantly increased (p < 0.001) from 16.47% to 27.59%. The proportion of intermediate grade disease significantly increased (p < 0.001) from 34.41% in 2011 to 39.08% in 2021. The mean maximum positive biopsy core percentage was lower in 2011 (48.00 + .33%) versus 2021 (55.00 + .29%) (p < 0.001). A non-parametric independent samples Kruskal-Wallis test with Bonferroni post hoc comparisons indicated that the median PSA levels were similar during 2011-2012 (6.7 – 6.9 ng/ml) and were significantly lower (p <.05) than the median PSA values measured during 2020-2021 (8.5 – 9 ng/ml). Study limitations include uncertainty about the extent of adoption of USPSTF guidelines in the practices, possible inaccurate attribution of causality (versus imaging and biomarker effects). Its strengths include prospective acquisition of granular data and findings that align with studies showing increases in metastatic disease and PCa-specific mortality during this interval. Conclusions: We identified a temporal association between the USPSTF 2012 recommendation against screening and increasing volume and proportion of high-grade prostate cancer. This trend was not reversed following the 2018 ‘Grade C’ revision to the USPSTF guideline. SOURCE OF Funding: None
