Have the USPSTF recommendations against screening caused more aggressive prostate cancer?

Reference

Butler SS, Muralidhar V, Zhao SG, et al. Prostate cancer incidence across stage, NCCN risk groups, and age before and after USPSTF Grade D recommendations against prostate-specific antigen screening in 2012. Cancer 2020;126(4):717-724.

Synopsis

These authors used data from the Surveillance, Epidemiology, and End Results database to look at prostate cancer incidence for the 2 years before and 3 years after the 2012 USPSTF prostate cancer screening recommendations. These data derive from 18 population-based registries that cover more than 25% of the US population. The authors looked at trends based on the American Joint Committee on Cancer stage at diagnosis (localized vs metastatic), the National Comprehensive Cancer Network risk group (low vs unfavorable [intermediate risk or high risk]), and age group (50 to 74 years vs 75 years or older). For each of these categories, the authors reported declines in the incidence of indolent disease and increases in aggressive disease. Their graphs, however, don't really show a clearly defined "step" where one might look and ask, "Hmm, what happened in 2012?" The USPSTF has issued recommendations against prostate cancer screening all the way back to 1996! So, for the authors to look only at what happened after 2012 is specious and dangerous. They provide no evidence that deferring a diagnosis represents a significant burden to men, assume that early treatment is beneficial in preventing metastatic disease, and completely ignore the harms of early treatment. A trend based on a single recommendation statement just doesn't pass the sniff test, especially when the recommendations (in this case, about a controversial screening modality) have been in place for 20 years.