PD38-03 USE OF PROSTATE SPECIFIC ANTIGEN SCREENING FOR VETERANS BEFORE, DURING, AND AFTER THE 2012 UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATIONS: AGE AND RACE RELATED DIFFERENCES

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (PD38)1 Apr 2020PD38-03 USE OF PROSTATE SPECIFIC ANTIGEN SCREENING FOR VETERANS BEFORE, DURING, AND AFTER THE 2012 UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATIONS: AGE AND RACE RELATED DIFFERENCES Daniel Becker, Temitope Rude, Dawn Walter, Chan Wang, Stacy Loeb, Huilin Li, Shannon Ciprut, Matthew Kelly, Steven Zeliadt, Angela Fagerlin, Herbert Lepor, Scott Sherman, Joseph Ravenell, and Danil Makarov* Daniel BeckerDaniel Becker More articles by this author , Temitope RudeTemitope Rude More articles by this author , Dawn WalterDawn Walter More articles by this author , Chan WangChan Wang More articles by this author , Stacy LoebStacy Loeb More articles by this author , Huilin LiHuilin Li More articles by this author , Shannon CiprutShannon Ciprut More articles by this author , Matthew KellyMatthew Kelly More articles by this author , Steven ZeliadtSteven Zeliadt More articles by this author , Angela FagerlinAngela Fagerlin More articles by this author , Herbert LeporHerbert Lepor More articles by this author , Scott ShermanScott Sherman More articles by this author , Joseph RavenellJoseph Ravenell More articles by this author , and Danil Makarov*Danil Makarov* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000917.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2012, the US Preventative Services Task Force (USPSTF) formally recommended against all PSA screening for prostate cancer. Notably, the USPSTF recommendation did not provide different recommendations based on demographic subgroups, even though the prostate cancer-specific mortality of Black men is 2-3 times higher than that of non-Black men, and men aged 55-69 receive higher benefit from PSA screening compared to other age groups. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation, and to determine if PSA screening was more likely to be ordered based on a Veteran’s race or age. METHODS: Using the VA Corporate Data Warehouse, we created 10 annual cohorts of PSA-eligible men covering 2009-2018. Eligible men were those aged 40-80 with a visit to a VA provider during the year and without a prior prostate cancer diagnosis. Our full cohort contained 22,217,252 men. We then identified all PSA tests performed in the VA to determine yearly rates of PSA screening. We calculated the adjusted probability of receiving PSA screening using a piecewise generalized mixed model. Probabilities were adjusted for comorbidity, marital status, wealth, and education. RESULTS: The overall rate of PSA testing in the VA decreased from 61% in 2009 to 50% in 2018 (p<0.001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 having the highest initial rate and greatest decline (71% in 2009 to 48% in 2018, p<0.001). Men aged 55-69 saw a smaller decline (65% in 2009 to 58% in 2018, p<0.001) while the youngest men, aged 40-54, had an increase in PSA screening (27% in 2009 to 37% in 2018, p<0.001). Unlike age groups, race was not significantly associated with a change in screening rates. CONCLUSIONS: In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than half of our cohort. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying age experienced significantly different trends in PSA screening, suggesting that the VA provides nuanced care to individuals, taking age into account when recommending prostate cancer screening. Source of Funding: Funding for this study was provided by the US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service grants CDA 11-257 and CDP 11-254 (Dr Makarov) and the Edward Blank and Sharon Cosloy–Blank Family Foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e802-e802 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Becker More articles by this author Temitope Rude More articles by this author Dawn Walter More articles by this author Chan Wang More articles by this author Stacy Loeb More articles by this author Huilin Li More articles by this author Shannon Ciprut More articles by this author Matthew Kelly More articles by this author Steven Zeliadt More articles by this author Angela Fagerlin More articles by this author Herbert Lepor More articles by this author Scott Sherman More articles by this author Joseph Ravenell More articles by this author Danil Makarov* More articles by this author Expand All Advertisement PDF downloadLoading ...