Decline of PSA Screening Rates Linked to Higher Rates of Metastatic Prostate Cancer

There is significant controversy around the benefit of prostate-specific antigen (PSA) screening due to conflicting results from studies related to screening efficacy. A new study presented at the 2022 American Society for Radiation Oncology Annual Meeting shows that lower facility-level PSA screening rates are linked with higher rates of metastatic prostate cancer (mPCa).

In this study, presenting author Alex K. Bryant, MD, MS, and colleagues used data from the US Veterans Health Administration to calculate yearly PSA screening rates, long-term nonscreening rates, and age-adjusted mPCa incidence rates from 2005 to 2019. Random effects linear regression analysis was used to assess the influence of annual PSA screening rates between 2010 and 2013 with the subsequent incidence of mPCa from 2014 to 2019, while adjusting for demographic factors.

The full study population included 4.7 million men in 2005, and the number of participants increased to 5.4 million in 2019. Study results showed that PSA screening rates dropped from a high of almost 51% in 2008 to 37% in 2019. Declines were observed across all age and race groups. Moreover, mPCa incidence increased from a low of 4.6 in 2008 to 7.9 in 2019. Overall, the analysis showed that lower facility-level PSA screening rates were correlated with higher subsequent mPCa incidence, with a 0.87 unit increase in 2014 to 2019 per 10% decrease in PSA screening rates between 2010 and 2013. The researchers also observed that higher long-term nonscreening rates were linked with higher subsequent mPCa incidence, with a 1.61 unit increase in 2014-2019 mPCa incidence rate per 10% increase in 2010-2013 long-term nonscreening rate.

The investigators concluded that 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.”

Source: Bryant AK, Lee KM, Alba PR, et al. Association of prostate-specific antigen screening rates and subsequent metastatic prostate cancer incidence in a national healthcare system. Abstract 298. Presented at the 2022 ASTRO Annual Meeting; October 23-26, 2022; San Antonio, TX.