MP58-20 USE OF LOW-VALUE PROSTATE-SPECIFIC ANTIGEN SCREENING AMONG YOUNG MEN WITH PRIVATE INSURANCE

Abstract

You have accessJournal of UrologyCME1 May 2022MP58-20 USE OF LOW-VALUE PROSTATE-SPECIFIC ANTIGEN SCREENING AMONG YOUNG MEN WITH PRIVATE INSURANCE Jeffrey Vehawn, Suzanne Lange, Mouneeb Choudry, Jacob Ambrose, Benjamin Haaland, Jonathan Chipman, Heidi A. Hanson, and Brock O'Neil Jeffrey VehawnJeffrey Vehawn More articles by this author , Suzanne LangeSuzanne Lange More articles by this author , Mouneeb ChoudryMouneeb Choudry More articles by this author , Jacob AmbroseJacob Ambrose More articles by this author , Benjamin HaalandBenjamin Haaland More articles by this author , Jonathan ChipmanJonathan Chipman More articles by this author , Heidi A. HansonHeidi A. Hanson More articles by this author , and Brock O'NeilBrock O'Neil More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Debate remains about the value of Prostate-specific antigen (PSA) based prostate cancer screening among men aged 55-69 (USPSTF Grade C). However, no professional society or guideline recommends PSA based prostate cancer screening in men younger than age 40. This study aims to understand the risk of PSA testing exposure in young men, and we hypothesize that substantial low-value testing occurs in this population. METHODS: We performed a retrospective analysis of claims data from the MarketScan database to identify men aged 18 to 39 without prostate cancer who received a PSA test from 2008 to 2017. For the primary analysis, men were required to be continuously in the database for least 5 years. Age groups were stratified to include: men less than 25, 25-29, 30-34, and 35-39 years.Secondary analysis did not limit subjects to those with 5 years of continuous data and explored the association of Charlson Comorbidity Index (CCI), lower urinary tract symptoms, erectile dysfunction, depression/anxiety, prostate cancer screening, infertility, and hypogonadism with PSA testing in young men. We used logistic regression to determine which of the factors were associated with PSA testing in young men. RESULTS: We identified claims for 40,164,773 adult men who met study criteria. Of these men, 3,230,748 were continuously in the Marketscan database for at least 5 years. The cumulative risk for receiving a PSA over 5 years for men under 40 is 2.5%. Stratified by age, men aged 35-39 are at highest risk. Logistic multivariable regression showed that, relative to all men between 18 and 40, patients in this age group who received a PSA were more likely to be diagnosed with hypogonadism (OR 20.55, 95% CI 20.39-20.71) or lower urinary tract symptoms (OR 9.34, 95% CI 9.26-9.41). Higher CCIs appeared to correlate with a decreased rate of PSA testing. This population was not significantly more likely to be diagnosed with infertility, depression, or anxiety. CONCLUSIONS: PSA screening for men under 40 is not uncommon, especially when associated with concomitant genitourinary symptoms. At a population level, this represents substantial low-value testing. Interventions aimed at clarifying the relationship between common urologic conditions and prostate cancer, the extremely low incidence of prostate cancer in this age group, and the lack of guidelines supporting this practice may help decrease low-value PSA testing. Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA234431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1000 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Vehawn More articles by this author Suzanne Lange More articles by this author Mouneeb Choudry More articles by this author Jacob Ambrose More articles by this author Benjamin Haaland More articles by this author Jonathan Chipman More articles by this author Heidi A. Hanson More articles by this author Brock O'Neil More articles by this author Expand All Advertisement PDF DownloadLoading ...