Prostate-specific Antigen Screening Rates Research Articles

Prostate Cancer Screening Uptake in Transgender Women

There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Rates of and factors associated with recent PSA screening in transgender women. Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.

The Association of County-level Prostate-specific Antigen Screening with Metastatic Prostate Cancer and Prostate Cancer Mortality

Background and objectiveThere exists ongoing debate about the benefits and harms of prostate-specific antigen (PSA) screening for prostate cancer. This study sought to evaluate the association of county-level PSA screening rates with county-level incidence of metastatic prostate cancer and prostate cancer mortality in the USA. MethodsThis ecological study used data from the 2004–2012 Behavioral Risk Factor Surveillance System (BRFSS) to build a multilevel mixed-effect model with poststratification using US Census data to estimate county-level PSA screening rates for all 3143 US counties adjusted for age, race, ethnicity, and county-level poverty rates. The exposure of interest was average county-level PSA screening rate from 2004 to 2012, defined as the proportion of men aged 40–79 yr who underwent PSA screening within the prior 2 yr. The primary outcomes were county-level age-adjusted incidence of regional/distant prostate cancer during 2015–2019 and age-adjusted prostate cancer mortality during 2016–2020. Key findings and limitationsA total of 416221 male BRFSS respondents aged 40–79 yr met the inclusion criteria and were used in the multilevel mixed-effect model. The model was poststratified using 63.4 million men aged 40–79 yr from all 3143 counties in the 2010 Decennial Census. County-level estimated PSA screening rates exhibited geographic variability and were pooled at the state level for internal validation with direct BRFSS state-level estimates, showing a strong correlation with Pearson correlation coefficients 0.77–0.90. A 10% higher county-level probability of PSA screening in 2004–2012 was associated with a 14% lower county-level incidence of regional/distant prostate cancer in 2015–2019 (rate ratio 0.86, 95% confidence interval [CI] 0.85–0.87, p < 0.001) and 10% lower county-level prostate cancer mortality in 2016–2020 (rate ratio 0.90, 95% CI 0.89–0.91, p < 0.001). Conclusions and clinical implicationsIn this population-based ecological study of all US counties, higher PSA screening rates were associated with a lower incidence of regional/distant prostate cancer and lower prostate cancer mortality at extended follow-up. Patient summaryUS counties with higher rates of prostate-specific antigen (PSA) screening had significantly lower rates of metastatic prostate cancer and prostate cancer mortality in subsequent years. These data may inform shared decision-making regarding PSA screening for prostate cancer.

Abstract C130: Increasing prostate cancer education and screening for black men in southeastern Michigan: Your prostate, your health

Abstract Background Black Men (BM) have disproportionately higher mortality rates from prostate cancer (PCa) and present with more advanced disease. Early screening may improve outcomes. The aim of our project was to provide education, screening, and provider outreach in efforts to decrease the disproportionate number of PCa deaths in Black men. Methods We conducted focus group discussions with BM to assess their perceptions and understanding of PCa and screening. Focus groups aided in the development of educational materials. Educational materials were distributed at community events. Attendants were asked to participate in a survey to assess their knowledge, interest, and perceptions of prostate cancer screening and diagnosis. Screening was offered, at select events, using prostate-specific antigen (PSA) testing. Men with PSA levels of ≥4 ng/ml were contacted for follow-up. The project included training for Henry Ford Health (HFH) providers and an assessment of their PCa screening practice. Results We completed 4 focus groups and distributed ~1000 PCa educational brochures. To date, 136 men completed the survey. The least common response (n=33, 21.17%) to signs and symptoms associated with prostate cancer was “Prostate cancer can have no symptoms.” while the most common response (n=108, 66.42%) stated that prostate cancer is associated with “Having a hard time passing urine.” The most common response (n=106, 79.1%) to the perceived barrier to prostate cancer screening was “Lack of education around the importance of screening.” Furthermore, when participants were asked why men do not get prostate cancer screening the most common response (n=119, 79.33%) was “Fear of diagnosis.” The greatest number of survey responses (n=90, 69.77%) stated that “Social Media” is how they learned about prostate cancer screening. The largest number of responses (n=83, 57.24%) for the preferred method of communication regarding getting a prostate cancer screening was, “Text message reminder to schedule an appointment.” We participated in 42 community events between March 2022 to May 2023. 323 men were screened. 27 men had an elevated PSA, and 14 of these men did not complete follow-up. The reasons for the lack of follow-up were inability to re-contact (n=10, 71%), lack of insurance (n=2, 14%), no show to appointment (n=1, 7%), fear (n=1, 7%), and unknown (n=1, 7%). HFH provider educational sessions were conducted. Of 129 providers who completed a screening practice assessment, 78 (60%) routinely offered PSA screening to men between ages 55-69. Between 2018 to 2023 at HFH, the PSA screening rate overall increased from 8.2% to 12.7%. Conclusion Although our outreach efforts were effective at increasing PSA screening, half the men with elevated PSA did not follow-up. Future efforts should further reduce barriers to PCa screening and follow-up. Citation Format: Shane A. Tinsley, Doreen Dankerlui, Camille Romain, Wilma Ruffin, Clarence Burnett, Donna Long, Karen Yacobucci, Jaye Clement, Abisola Fasakin, Biola Makinde-Odusola, Eric Williams, Tiffany Fields, Firas Abdollah, Daniel Moore, Clara Hwang, Eleanor M. Walker. Increasing prostate cancer education and screening for black men in southeastern Michigan: Your prostate, your health [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C130.

Detection of Prostate Cancer Screening Disparities Using Geospatial Analysis of Laboratory Results

Abstract Black men experience higher prevalence and mortality from prostate cancer (PCa) but are less likely to undergo PCa screening with prostate-specific antigen (PSA). The reasons for this disparity are multifactorial and include lack of access, PCa education, and mistrust in the healthcare system. Identifying geographic regions with low PSA screening and high positivity rates could potentially help inform targeted interventions. This study aimed to examine racial, socioeconomic, and geospatial disparities in PSA screening and positivity rates in the Siteman Cancer Center (St. Louis, MO) catchment region. The results of all PSA screening tests ordered in the Barnes-Jewish Healthcare Corporation (St. Louis, MO) and performed from 9/2019-12/2022 were retrieved from the laboratory information system with patient demographics. Patient addresses were geocoded using ArcGIS Pro (ESRI, Redlands, CA) and assigned to a census tract of residence. The PSA screening-eligible population was defined as the number of persons ≥50 years of age based on U.S. Census data. Social Vulnerability Index (SVI) values were retrieved from the Centers for Disease Control. The PSA screening rate was calculated by census tract as the total number of PSA tests performed/PSA screening-eligible population. The PSA positivity rate was calculated by census tract as the number of PSA positive tests/total PSA tests. All census tracts with fewer than 10 PSA tests performed were omitted from PSA positivity analysis. Hotspot analysis was performed by calculating Local Moran’s I statistic per census tract and comparing with 999 randomly-generated maps. A total of 90,994 screening tests for 60,005 patients (48,024 White [80%], 10,425 Black [17%], and 1,556 Other [3%]) were performed for patients in the catchment region. Black patients were 78% more likely to receive a positive PSA screen than White patients (p&amp;lt;0.001). Of those screening positive, Black patients had a significantly higher median[IQR] (7.94[6.2-13.7 ng/mL]) PSA result compared to White patients (7.4[6.2-10.1 ng/mL]) (p&amp;lt;0.001) and a median[IQR] age of 67[61-74 years] vs. 69[63-76 years] (p&amp;lt;0.001). In a multivariate logistic regression using age, race, and census tract of residence SVI to predict PSA positivity, only census tract SVI was not statistically significant. A model using only age and race demonstrated that every 10 years of age and Black race were associated with 11% and 7% increased odds of receiving a PSA positive test, respectively (p&amp;lt;0.001). 75 and 191 of 789 census tracts in the catchment region were identified as PSA positivity hotspots and PSA screening cold spots, respectively. In conclusion, this study confirms previous reports of higher PSA values among Black patients and suggests that geospatial analysis of PSA testing can identify geographic regions with low testing and high positivity rates.

Disparities Associated with Shared Decision-making in Prostate Cancer Screening

BackgroundProstate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist. ObjectiveTo examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening. Design, setting, and participantsA retrospective cross-sectional study was conducted among men aged 45–75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed. Outcome measurements and statistical analysisOur primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations. Results and limitationsA total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081–1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287–1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150–1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240–1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865–1.364, p = 0.477). The lack of important clinical data remains a limitation. ConclusionsOverall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men. Patient summaryWe evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

Low-Value Prostate-Specific Antigen Screening in Older Males

The US Preventive Services Task Force guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in males older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. However, this low-value PSA screening in males aged 70 years or older remains common. To characterize the factors associated with low-value PSA screening in males 70 years or older. This survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention that collects information via telephone from more than 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. The final cohort comprised male respondents to the 2020 BRFSS survey who were categorized into the following age groups: 70 to 74 years, 75 to 79 years, or 80 years or older. Males with a former or current prostate cancer diagnosis were excluded. The outcomes were recent PSA screening rates and factors associated with low-value PSA screening. Recent screening was defined as PSA testing within the past 2 years. Weighted multivariable logistic regressions and 2-sided significance tests were used to characterize factors associated with recent screening. The cohort included 32 306 males. Most of these males (87.6%) were White individuals, whereas 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic individuals. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were aged 75 to 79 years, and 28.9% were 80 years or older. The recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. Among all racial groups, non-Hispanic White males had the highest screening rate (50.7%), and non-Hispanic American Indian males had the lowest screening rate (32.0%). Screening increased with higher educational level and annual income. Married respondents were screened more than unmarried males. In a multivariable regression model, discussing PSA testing advantages with a clinician (odds ratio [OR], 9.09; 95% CI, 7.60-11.40; P < .001) was associated with increased recent screening, whereas discussing PSA testing disadvantages had no association with screening (OR, 0.95; 95% CI, 0.77-1.17; P = .60). Other factors associated with a higher screening rate included having a primary care physician, a post-high school educational level, and income of more than $25 000 per year. Results of this survey study suggest that older male respondents to the 2020 BRFSS survey were overscreened for prostate cancer despite the age cutoff for PSA screening recommended in national guidelines. Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males.

MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN

You have accessJournal of UrologyCME1 Apr 2023MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN Benjamin V. Stone, Muhieddine Labban, Dejan K. Filipas, Edoardo Beatrici, Nicola Frego, Zhiyu (Jason) Qian, Sandeep S. Voleti, Stuart R. Lipsitz, Adam S. Kibel, Alexander P. Cole, and Quoc-Dien Trinh Benjamin V. StoneBenjamin V. Stone More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Nicola FregoNicola Frego More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Sandeep S. VoletiSandeep S. Voleti More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There exist disparities in prostate-specific antigen (PSA) screening and prostate cancer outcomes among racial and ethnic groups, but it is unknown how limited English proficiency impacts rates of PSA screening. METHODS: The Medical Expenditure Panel Survey was utilized to identify rates of PSA screening between 2013 and 2016 among men without prostate cancer ≥55 for whom guidelines recommend shared decision-making regarding prostate cancer screening. Men were stratified by self-reported levels of English proficiency (men who speak English very well, well, not well, or not at all). Survey weights were applied, and groups were compared using the adjusted Wald test. A multivariable logistic regression model was used to identify predictors of ever receiving PSA screening adjusting for patient-level covariates. RESULTS: The cohort included 2,889 men, corresponding to a weighted national estimate of 4,765,682 men. The rates of PSA screening varied significantly according to levels of English proficiency (p<0.0001, Figure 1). 79.6% of men who speak English very well reported receiving at least one lifetime PSA test, compared with 58.4% of men who do not speak English at all (p<0.001). Approximately half of the men who speak English very well reported PSA testing within the prior year (52.0%) compared with 34.5% of men who do not speak English at all. Significant predictors of receiving at least one lifetime PSA test included older age, income >400% of the federal poverty level, and insurance coverage (Table 1). Asian compared to White race was associated with lower rates of PSA screening (aOR 0.35; 95% CI 0.21-0.60; p<0.001). Compared to those who reported speaking English very well, men who reported not speaking English at all had significantly lower rates of PSA screening (aOR 0.55; 95% CI 0.35-0.88; p=0.012). CONCLUSIONS: Limited English proficiency is associated with significantly lower rates of PSA screening. Interventions to mitigate disparities in prostate cancer outcomes need to account for limited English proficiency among the barriers to guideline-concordant care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin V. Stone More articles by this author Muhieddine Labban More articles by this author Dejan K. Filipas More articles by this author Edoardo Beatrici More articles by this author Nicola Frego More articles by this author Zhiyu (Jason) Qian More articles by this author Sandeep S. Voleti More articles by this author Stuart R. Lipsitz More articles by this author Adam S. Kibel More articles by this author Alexander P. Cole More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of Prostate-Specific Antigen Screening Rates and Subsequent Metastatic Prostate Cancer Incidence in a National Healthcare System

<h3>Purpose/Objective(s)</h3> There is substantial controversy about the benefit of prostate-specific antigen (PSA) screening. PSA screening rates have declined since 2008 due to changing practice guidelines and conflicting clinical trial results regarding the benefit of screening. Since then, the incidence of metastatic prostate cancer (mPCa) has risen; however, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent mPCa rates. <h3>Materials/Methods</h3> We used data from the United States Veterans Healthcare Administration (VHA) to calculate yearly PSA screening rates, long-term non-screening rates (no PSA measured in prior three years), and age-adjusted mPCa incidence rates from 2005 to 2019. Rates are reported per 100,000 men and were aggregated by race, age group, and VHA facility (128 facilities). We used random effects linear regression to examine the influence of yearly facility-level PSA screening rates from 2010-2013 on subsequent facility-level mPCa incidence from 2014-2019, adjusting for population demographics. <h3>Results</h3> The cohort included 4.7 million men in 2005 and increased to 5.4 million in 2019. PSA screening rates declined from a high of 50.8% in 2008 to 37% in 2019, with declines in all age and race groups; the long-term non-screening rate similarly increased in this period. mPCa incidence increased from a low of 4.6 in 2008 to 7.9 in 2019, driven by increases in the 55-69 and 70+ year old age groups. Lower facility-level PSA screening rates were associated with higher subsequent mPCa incidence (0.87 unit increase in 2014-2019 mPCa incidence rate per 10% decrease in 2010-2013 PSA screening rate, 95% confidence interval [CI] 0.58 to 1.15, p<0.001). Similarly, higher long-term non-screening rates were associated with higher subsequent mPCa incidence (1.61 unit increase in 2014-2019 mPCa incidence rate per 10% increase in 2010-2013 long-term non-screening rate, 95% CI 1.14 to 2.08, p<0.001). <h3>Conclusion</h3> From 2008 to 2019, PSA screening rates declined and long-term non-screening rates increased in the national VHA system. Lower facility-level PSA screening rates were associated with higher subsequent rates of mPCa. These data can be used to inform shared decision making about the potential benefits of PSA screening in men who wish to reduce their risk of prostate cancer metastases.

Prostate Cancer Screening Disparities in Persons Experiencing Homelessness.

The purpose of this study was to assess prostate-specific antigen (PSA) testing rates in persons experiencing homelessness (PEH), identify factors associated with screening, and compare PSA screening rates in PEH with a matched cohort of persons not experiencing homelessness (non-PEH). We identified 9,249 potentially eligible PEH cared for at a large metropolitan hospital system from an institutional registry of all patients who presented to the health care system as homeless from 2014 to 2021. Homelessness was defined by the presence of the Z-code for homelessness (Z59), the listed address matching to the address of a homeless shelter or other transitional housing or a positive screen for homelessness. A matched cohort of 10,000 non-PEH was generated for comparison. Univariate chi-square analysis and multivariate logistic regression were performed to evaluate variables associated with PSA testing. A total of 1,605 PEH and 3,413 non-PEH were eligible for PSA screening within the study timeframe. Half of PEH were Black (50%). Medicaid was the most common insurance (51%), followed by Medicare (18%). PEH were less likely to have a PCP (58% v 81%, P < .001) and had a significantly lower PSA testing rate (13% v 34%, P < .001) compared with non-PEH. Univariate analysis revealed that PSA testing was more common in PEH who were employed (P < .001), had private insurance or Medicare (P < .001), or had an established primary care provider (PCP; P < .001). Multivariate analysis confirmed that having a PCP (OR, 2.54; 95% CI, 1.62 to 4.00; P < .001) significantly increased the likelihood of PSA testing in PEH. PEH experience low rates of prostate cancer screening. Interventions to increase screening in this population, including increased PCP access, are needed.

Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

There is controversy about the benefit of prostate-specific antigen (PSA) screening. Prostate-specific antigen screening rates have decreased since 2008 in the US, and the incidence of metastatic prostate cancer has increased. However, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent metastatic prostate cancer rates. To assess whether facility-level variation in PSA screening rates is associated with subsequent facility-level metastatic prostate cancer incidence. This retrospective cohort used data for all men aged 40 years or older with an encounter at 128 facilities in the US Veterans Health Administration (VHA) from January 1, 2005, to December 31, 2019. Yearly facility-level PSA screening rates, defined as the proportion of men aged 40 years or older with a PSA test in each year, and long-term nonscreening rates, defined as the proportion of men aged 40 years or older without a PSA test in the prior 3 years, from January 1, 2005, to December 31, 2014. The main outcomes were facility-level yearly counts of incident metastatic prostate cancer diagnoses and age-adjusted yearly metastatic prostate cancer incidence rates (per 100 000 men) 5 years after each PSA screening exposure year. The cohort included 4 678 412 men in 2005 and 5 371 701 men in 2019. Prostate-specific antigen screening rates decreased from 47.2% in 2005 to 37.0% in 2019, and metastatic prostate cancer incidence increased from 5.2 per 100 000 men in 2005 to 7.9 per 100 000 men in 2019. Higher facility-level PSA screening rates were associated with lower metastatic prostate cancer incidence 5 years later (incidence rate ratio [IRR], 0.91 per 10% increase in PSA screening rate; 95% CI, 0.87-0.96; P < .001). Higher long-term nonscreening rates were associated with higher metastatic prostate cancer incidence 5 years later (IRR, 1.11 per 10% increase in long-term nonscreening rate; 95% CI, 1.03-1.19; P = .01). From 2005 to 2019, PSA screening rates decreased in the national VHA system. Facilities with higher PSA screening rates had lower subsequent rates of metastatic prostate cancer. These data may be used to inform shared decision-making about the potential benefits of PSA screening among men who wish to reduce their risk of metastatic prostate cancer.

Racial Disparities in Patient Perspectives on Shared Decision Making in Prostate Cancer Screening Following 2018 Guideline Changes

<h3>Purpose/Objective(s)</h3> The 2018 US Preventive Services Task Force (USPSTF) guidelines recommend individualizing prostate cancer screening in 55–69-year-old men with discussion of risks, benefits, values, and preferences. Given the two-fold higher incidence of prostate cancer in African-American (AA) compared to non-Hispanic white (NHW) men, we compared patient perspectives on shared decision making on prostate specific antigen (PSA) screening, hypothesizing that the rate of screening and discussion of risks/benefits would not be commensurate with the relative risk between these two groups. <h3>Materials/Methods</h3> We used the Behavioral Risk Factor Surveillance System's nationwide survey data on screening-eligible men based on these guidelines to assess patterns of PSA testing. We also performed subset analysis of men interviewed on perspectives of shared decision making for PSA screening. We used weighted Poisson regression and Kruskal-Wallis rank sum tests to compare the rate of PSA screening in the past 2 years; rate of shared, individual, and provider decision to perform PSA testing; and patient-reported education on PSA advantages and disadvantages. <h3>Results</h3> We identified 43,685 men (40,301 NHW and 3,384 AA) aged 55-70 interviewed about PSA screening in 2020. AA men were more likely than NHWs to be uninsured (10.5% versus 5.6% p<0.001) and to report cost barriers to accessing care (10.7% versus 5.5% p<0.001). AA men reported 12.8% lower rate of screening (95% confidence interval (95% CI) -12.6 to -13.0 p<0.001) than NHWs. Estimates remained similar and statistically significant in multivariable and sequential regression analyses adjusting for socioeconomic and care access factors. AA and NHW men reported similar rates of education regarding advantages of PSA screening: 54.6% and 55.4%, respectively (p = 0.38), although AA men were significantly more likely than NHWs to report education on disadvantages of screening: 32% versus 24.6% (p<0.001). Finally, in subset analysis of 735 men asked about who made the decision to undergo PSA screening, AA men were 31.8% less likely to report a shared decision with their provider (95% CI -30.2 to -33.3 p<0.001) and 14.6% (95% CI 12.5 to 16.6 p<0.001) more likely to report making the decision themselves than NHWs. <h3>Conclusion</h3> Despite prostate cancer being more common and fatal in AA than NHW men, PSA screening and education patterns do not reflect this increased risk even when adjusting for socioeconomic and health access disparities. In addition to lower PSA screening rates, AA men reported lower rates of shared decision making than NHW men and a greater recollection of education on the disadvantages of PSA screening. This could represent distrust in the medical system by AA men, as well as systemic racial bias leading to reduced screening or poorer communication with AA men. Overall, these findings suggests that there remains room for improvement in how physicians address risk stratification and racial biases in counseling patients on PSA screening.

Prostate Cancer Screening Disparities in Persons Experiencing Homelessness

<h3>Purpose/Objective(s)</h3> Persons experiencing homelessness (PEH) face barriers to cancer screening, leading to cancer diagnosis at more advanced stages. Data on prostate specific antigen (PSA) screening in this population is scarce. The aim of this study was to 1) assess PSA testing rates in PEH and identify factors associated with screening and 2) compare PSA screening rates in PEH with persons not experiencing homelessness (non-PEH). <h3>Materials/Methods</h3> This is an IRB approved study of PEH and non-PEH cared for at a large metropolitan hospital system from 2014 to 2021. We identified PEH from a prospective institutional registry which started screening for homelessness in January 2014. Homelessness was defined by either the presence of the Z-code for homelessness (Z59) within the medical record, the listed address was matched to homeless shelters or other transitional housing, or the patient identified as homeless. Institutional CPT and HCPCS billing codes for PSA testing were available beginning 01/01/2017 and cross-referenced to identify patients who underwent PSA testing at least once between 01/01/2017 and 12/31/2021. We extracted PSA testing information for a matched cohort of non-PEH based on sex, age, county of residence, and date of last encounter for comparison. We included men ages 50-69 that lived in our institution's county or an immediately adjacent county. The primary outcome was to assess the rate of PSA testing in the past 5 years in accordance with national screening guidelines (USPSTF, AUA, ACS) and to identify factors associated with PSA testing in PEH. <h3>Results</h3> A total of 9,249 PEH were identified, with 1,605 eligible for PSA screening (men between ages 50-69) within the study timeframe; 3,421 non-PEH were eligible for screening comparison. The median age of PEH was 58.0 years old and the majority of PEH were Black (50%) or White (43%). 67% of PEH were current tobacco users, 52% current alcohol users, and 34% current illicit drug users. Medicaid was the most common insurance (51%) followed by Medicare (19%) and private insurance (4%). PEH were less likely to have a PCP (58% vs 81%, p<0.001) and had a significantly lower PSA testing rate (13% vs 34%, p<0.001) compared to non-PEH. On univariate analysis, PEH were more likely to be Black (p<0.001), single (p<0.001), unemployed (p<0.001) and have Medicaid/no insurance (p<0.001). On multivariate analysis, each of these associations remained significant; most notably, lack of a PCP (OR=1.78; 95% CI 1.35-2.30, p<0.001) or PSA testing (OR=1.63; 95% CI, 1.25-2.14, p<0.001) were associated with increased odds of being homeless. Within the homeless population, multivariate analysis showed that having a PCP (OR=2.58; 95% CI, 1.64-4.05) significantly increased the odds of getting PSA testing. <h3>Conclusion</h3> PEH experience low rates of prostate cancer screening. Interventions to increase screening in this population, including increased PCP access, are warranted.

Impact of COVID-19 on the incidence of localized and metastatic prostate cancer among White and Black Veterans.

The COVID‐19 pandemic disrupted prostate‐specific antigen (PSA) screening and prostate biopsy procedures. We sought to determine whether delayed screening and diagnostic workup of prostate cancer (PCa) was associated with increased subsequent rates of incident PCa and advanced PCa and whether the rates differed by race. We analyzed data from the Veterans Health Administration to assess the changes in the rates of PSA screening, prostate biopsy procedure, incident PCa, PCa with high‐grade Gleason score, and incident metastatic prostate cancer (mPCa) before and after January 2020. While the late pandemic mPCa rate among White Veterans was comparable to the pre‐pandemic rate (5.4 pre‐pandemic vs 5.2 late‐pandemic, p = 0.67), we observed a significant increase in incident mPCa cases among Black Veterans in the late pandemic period (8.1 pre‐pandemic vs 11.3 late‐pandemic, p < 0.001). Further investigation is warranted to fully understand the impact of the COVID‐19 pandemic on the diagnosis of advanced prostate cancer.

Grade Migration of Prostate Cancer in the United States During the Last Decade.

Prostate cancer (PC) screening guidelines have changed over the last decade to reduce overdiagnosis and overtreatment of low-grade disease. We sought to examine and attempt to explain how changes in screening strategies have impacted temporal trends in Gleason grade group (GG) PC at diagnosis and radical prostatectomy pathology. Using the Surveillance, Epidemiology, and End Results Registry database, we identified 438 432 men with newly diagnosed PC during 2010-2018. Temporal trends in incidence of GG at biopsy, radical prostatectomy pathology, prostate-specific antigen (PSA) level, and metastasis at diagnosis were examined. The National Health Interview Survey database was examined to evaluate trends in PSA-screening rates, and a literature review evaluating magnetic resonance imaging and biomarkers utilization during this period was performed. Between 2010 and 2018, the incidence of low-grade PC (GG1) decreased from 52 to 26 cases per 100 000 (P < .001). The incidence of GG1 as a proportion of all PC decreased from 47% to 32%, and the proportion of GG1 at radical prostatectomy pathology decreased from 32% to 10% (P < .001). However, metastases at diagnosis increased from 3.0% to 5.2% (P < .001). During 2010-2013, PSA screening rates in men aged 50-74 years declined from 39 to 32 per 100 men and remained stable. Utilization rates of magnetic resonance imaging and biomarkers modestly increased from 7.2% in 2012 to 17% in 2019 and 1.3% in 2012 to 13% in 2019, respectively. We found a significant decrease in the diagnosis and treatment of GG1 PC between 2010 and 2018. Changes in PSA screening practices appear as the primary contributor. Public health efforts should be directed toward addressing the increase in the diagnoses of metastatic PC.

Comparison of prostate specific antigen testing in men aged 55 to 69 with and without a history of cancer.

230 Background: Prostate specific antigen (PSA) screening remains a controversial issue. However, most urological guidelines recommend PSA testing through a shared decision-making process with the patient. The rate of PSA screening in men with a history of cancer compared to men with no cancer history is not well known. We aimed to compare PSA testing in men aged 55-69 years with and without a history of cancer (excluding prostate cancer patients). Methods: Utilizing the National Health Interview Survey (NHIS) a retrospective cross-sectional study between the years 2015 and 2018 was carried out to analyze and compare PSA testing rates in men aged 55-69 years. Multivariable logistic regression model was implemented do demonstrate potential associations with PSA testing. Results: A total of 13,850 men aged 55-69 years included in the NHIS Survey were analyzed. 1519 (10.9%) men had a history of cancer (non-prostate). On multivariable analysis, men who were previously diagnosed with cancer had a higher rate of PSA testing compared to men with no history of cancer (OR: 1.88, 95% CI 1.39-2.54, p &lt; 0.001). Other factors associated with an increased likelihood of undergoing PSA testing included: age, homosexual orientation, and married men. In contrast, current smokers, American Indians and Alaskan Natives and Asians were less likely to undergo PSA testing. Conclusions: Our data suggest that men aged 55-69 with a history of cancer are more likely to undergo PSA testing than men with no cancer history.[Table: see text]

Impact of COVID-19 on the incidence of prostate cancer among White and Black Veterans.

29 Background: Early-stage prostate cancer (PCa) is typically detected on prostate-specific antigen (PSA) screening and subsequent prostate biopsy, healthcare interventions that are considered routine elective procedures. The COVID-19 pandemic disrupted routine healthcare screenings and interventions. We sought to determine whether delayed screening and diagnostic workup of PCa was associated with increased rates of incident PCa, high-grade Gleason, and metastatic disease at diagnosis. Methods: We used the Corporate Data Warehouse of the Veterans Health Administration to collect PSA, prostate biopsy, PCa diagnosis, Gleason score, and metastasis information of White and Black Veterans aged 40 years or older newly diagnosed with PCa from January 2019 through June 2021. For each month, we calculated rates of PSA, prostate biopsy, and incident PCa per 100,000 men and plotted monthly rates by race. We performed descriptive analyses to compare age at first PSA, age at diagnosis, baseline PSA, Gleason scores, and metastasis pre- and post-January 2020, the month in which the U.S. declared COVID-19 a public health emergency. Results: The decrease in the rate of PSA screening immediately after January 2020 was similar in both White and Black Veterans (7% vs. 6%). However, the magnitude of reduction in the rate of prostate biopsy and the rate diagnosis of incident PCa were five times larger among Black Veterans compared to White Veterans (11% vs. 2% for both biopsy and diagnosis rates). Among the 17,771 White and 9,610 Black Veterans with incident PCa, the rate of Gleason of 4+3 or greater and the rate of metastatic disease at diagnosis increased three months after the pandemic in both race groups with comparable magnitude (2-3% increase in high-grade Gleason, 1% increase in metastatic disease). Conclusions: Utilization patterns indicated that while the decrease in PSA screening after the pandemic was similar in White and Black Veterans, reductions in prostate biopsy and diagnosis of incident PCa were five times greater in Blacks than Whites. Further research including risk-adjusted modeling is needed to determine whether Black Veterans were disproportionately affected by the pandemic-related disruptions in PSA screening and diagnostic workup of prostate cancer.[Table: see text]

Acquired and Congenital Spinal Cord Injury is Associated With Lower Likelihood of Prostate Specific Antigen Screening

ObjectiveTo evaluate prostate cancer screening occurrence in patients with spinal cord injury at our institution compared to a matched, unaffected population. Materials and MethodsWe conducted a retrospective review of patients with the criteria: male, age 50-70, and diagnosis of cerebral palsy, spina bifida, or quadriplegia. A control cohort was matched by age, race, insurance, and co-morbidities. Prostate specific antigen (PSA) screening, PSA value, prostate MRI, prostate biopsy, and biopsy outcome were compared. Multivariate logistic regression analysis was performed to determine the association between patient variables and PSA screening. ResultsThe study cohort and control cohort included 2180 patients each. Patients with spinal cord injury had significantly lower rates of PSA screening (15% vs 24%, P <.00001), MRI (0.1% vs 0.6%, P = .02), and biopsy (0.6% vs 1.3%, P = .01) compared to control. Spinal cord injury was associated with a lower likelihood of PSA screening (OR = 0.56, CI = 0.48-0.65, P <.00001). There were no significant differences in PSA value and biopsy outcomes. ConclusionPatients with spinal cord injury had a lower likelihood of PSA screening compared to a matched control population. Since PSA screening is a shared-decision making process, providers should consider the increasing life expectancy of patients with spinal cord injury and risks of under-testing for prostate cancer.

Prostate Cancer Screening and Incidence among Aging Persons Living with HIV.

The risk of prostate cancer among persons living with human immunodeficiency virus (PWH) is not well understood and may be obscured by different opportunities for detection. We identified 123,472 (37,819 PWH and 85,653 comparators) men enrolled in the Veterans Aging Cohort Study, a prospective national cohort of PWH and demographically matched, uninfected comparators in 2000-2015. We calculated rates of prostate specific antigen (PSA) testing by human immunodeficiency virus (HIV) status and fit multivariable Poisson models comparing the rates of PSA testing, prostate biopsy, and cancer incidence. The mean age at enrollment was 52 years. Rates of PSA testing were lower in PWH versus uninfected comparators (0.58 versus 0.63 tests per person-year). Adjusted rates of PSA screening and prostate biopsy were lower among PWH (incidence rate ratio [IRR] 0.87, 95% CI 0.75-0.84 and IRR 0.79 95% CI 0.74-0.83, respectively). The crude IRR for prostate cancer was lower in PWH versus controls (IRR 0.90, 95% CI 0.83-0.97). However, in a multivariable model adjusting for PSA testing, cancer incidence was similar by HIV status (IRR=0.93, 95% CI 0.86-1.01, p=0.08). Among patients who received a prostate biopsy, incidence of prostate cancer did not differ significantly by HIV status (IRR 1.06, 95% CI 0.98-1.15, p=0.15). Among incident cancers, there were significant differences in the distributions of Gleason grade (p=0.05), but not cancer stage (p=0.14) by HIV status. When accounting for less PSA testing among PWH, the incidence of prostate cancer was similar by HIV status. These findings suggest that less screening contributed to lower observed incidence of prostate cancer in PWH.

PD50-11 CHANGES IN PSA SCREENING RELATIVE TO THE REVISED USPSTF GUIDANCE FOR PROSTATE CANCER SCREENING

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-11 CHANGES IN PSA SCREENING RELATIVE TO THE REVISED USPSTF GUIDANCE FOR PROSTATE CANCER SCREENING Michael Leapman, Rong Wang, Cary Gross, and Xiaomei Ma Michael LeapmanMichael Leapman More articles by this author , Rong WangRong Wang More articles by this author , Cary GrossCary Gross More articles by this author , and Xiaomei MaXiaomei Ma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In April 2017 the United States Preventive Services Task Force (USPSTF) published a draft guideline that reversed 2012 guidance against routine screening for prostate cancer, instead endorsing individual decision-making (a ‘Grade C’ recommendation) for men aged 55-69 but continued to discourage screening for patients >70 years. We estimated the effects of the guideline change on prostate specific antigen (PSA) testing practices in a large privately insured population in the U.S. METHODS: We accessed claims from Blue Cross Blue Shield, the largest private commercial insurance carrier, to evaluate trends in PSA testing among patients aged 40-89 years from January 1, 2013 through December 31, 2019 with continuous insurance for at least 12 months. We calculated crude and age-adjusted rates of PSA screening based on laboratory and procedure codes. We used interrupted time series analyses to evaluate the effects of the draft (April 2017) and published (May 2018) USPSTF guideline on rates of PSA testing. We further examined effects within the subset of age across commonly used cutoffs for screening identified in the guideline (40-54, 55-69, and 70-89 years). RESULTS: We identified a cohort of 17,553,527 eligible insurance beneficiaries. In the period preceding the 2017 statement, the PSA testing rate was 33.3 per 100 person-years (standard deviation, SD 1.24). Rates of testing increased following the publication of the draft guideline to 35.2 per 100 person-years (SD 1.60). Interrupted time series analysis revealed a significant increasing time trend in the post-draft period, across all age groups (p<0.01). The largest overall increases occurred among beneficiaries aged 50-69 years (from 50.0 to 54.1 per 100 person-years, p<0.001) in the periods before and after the guideline change, respectively. CONCLUSIONS: Rates of PSA testing increased following changes to the USPSTF’s draft statement in 2017, reversing trends seen following earlier guidance against PSA testing for all patients. Increases in testing among older patients may renew concerns about the clinical application of PSA testing to individuals less likely to benefit. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e856-e856 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Leapman More articles by this author Rong Wang More articles by this author Cary Gross More articles by this author Xiaomei Ma More articles by this author Expand All Advertisement Loading ...

Association of increased intensity of prostate-specific antigen screening in younger African American men with improved prostate cancer outcomes.

5004 Background: African-American (AA) men are substantially more likely to present with lethal prostate cancer (PCa) at younger ages than non-Hispanic White men. Despite this disparity, AA men are poorly represented in the prostate-specific antigen (PSA) screening studies on which evidence-based PCa screening guidelines are based. This limits proper PSA screening guidance for AA men, especially for those younger than 55. We examined associations of PSA screening intensity with disease severity at diagnosis and prostate cancer-specific mortality (PCSM) in AA men &lt; 55 years of age. Methods: The earliest recommended age to begin discussion of PSA screening is 40 years. We identified AA men aged 40-55 years, diagnosed with PCa from 2004 to 2017 within the Veterans Health Administration. PSA screening was identified using procedural codes. Screening intensity was defined as percentage of years screened within the pre-diagnostic observation period. This included up to 5 years prior to diagnosis. Multivariable logistic regression assessed the influence of PSA screening intensity on metastatic disease at diagnosis. Lead-time correction using published screening-dependent lead times was performed. PCSM was evaluated using Fine-Gray regression and non-cancer death as a competing event. Additional analysis was performed stratifying PSA screening into ‘High’ and ‘Low’ groups centered on the mean. Results: The cohort included 4,654 AA men at a mean age of 51.8 years with mean PSA screening rate of 53.2%. The pre-diagnostic observation period ranged from 1 to 5 years (median = 5 years). Median follow-up was 7 years. At diagnosis, there was a higher prevalence of Gleason sum ≥ 8 (Grade Group ≥ 4) and metastatic disease in the ‘Low’ group compared with the ‘High’ group ([Gleason sum ≥ 8 (Grade Group ≥ 4)]: 18.6% vs. 14.4%, p &lt; 0.01; Metastatic disease at diagnosis: 3.7% vs. 1.4%, p &lt; 0.01). Increased PSA screening intensity was associated with significantly reduced odds of metastatic disease at diagnosis (odds ratio: 0.61, 95% confidence interval (CI) = [0.47-0.81], p &lt; 0.01) and decreased risk of PCSM (sub-distribution hazard ratio: 0.75, 95% CI = [0.59-0.95], p = 0.02). Conclusions: In this large national cohort of AA men aged 40 to 55 years, PSA screening increased intensity was associated with decreased risk of lethal disease and metastases at time of diagnosis and decreased PCSM. These data support the hypothesis that PSA screening and early prostate cancer detection may improve outcomes in younger AA men.