In a survey study reported in JAMA Network Open, Kalavacherla et al found a high prevalence of prostate-specific antigen (PSA) screening for prostate cancer among older patients than recommended for such screening in U.S. Preventive Services Task Force guidelines.
The investigators stated: “The U.S. Preventive Services Task Force guidelines advise against…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.”
Study Details
The 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 U.S. adults on behavioral risk factors, chronic illnesses, and use of preventive services. The study cohort consisted of 32,306 male respondents categorized according to age 70–74 years (42.8%), 75–79 years (28.4%), and ≥ 80 years (28.9%). Men with former or current prostate cancer diagnosis were excluded. Recent PSA screening was defined as PSA testing within the prior 2 years.
Key Findings
In the study cohort, 87.6% of respondents were White, 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic. Recent PSA screening rates were 55.3% in men aged 70–74 years, 52.1% in those aged 75–79 years, and 39.4% in those aged ≥ 80 years.
Screening rates differed across racial/ethnic groups (overall P < .001), with the highest rate among White males (50.7%) and the lowest among American Indian males (32.0%). Rates increased with higher educational level (P < .001), with the highest rates in those with a college degree (56.7%) and the lowest in those with no high school diploma or attendance (30.3%). Rates increased with higher annual income. Rates differed by marital status (P < .001), with the highest rate in married males (54.4%) followed by those in an unmarried partnership (48.2%) and those who were divorced, widowed, or separated (41.5%).
On multivariate analysis, race/ethnicity were not associated with recent screening. Compared with an annual income less than $25,000, income higher than $25,000 was associated with recent screening; odds ratios (ORs) were 1.39 (95% confidence interval [CI] = 1.10–1.75, P = .006) for those with income between $25,000 and $50,000 and 1.36 (95% CI = 1.03–1.81, P = .03) among those with income higher than $50,000. Compared with no high school diploma or attendance, high school diploma or GED certificate (OR = 1.46; 95% CI = 1.07–2.00, P = .02), some college (OR = 1.79, 95% CI = 1.32–2.43, P < .001), and college degree (OR = 1.93, 95% CI = 1.40–2.66, P < .001) were associated with recent screening. Compared with married males, those who were divorced, widowed, or separated were less likely to be recently screened (OR = 0.82, 95% CI = 0.68–0.98, P = .30).
On multivariate analysis, factors associated with increased screening included having a primary care physician (OR = 1.89, 95% CI = 1.41–2.53, P < .001) and discussing the advantages of PSA testing with a clinician (OR = 9.09, 95% CI = 7.60–11.40, P < .001). Discussion of the disadvantages of PSA testing with a clinician had no significant association with screening (OR = 0.95, 95% CI = 0.77–1.17, P = .60).
The investigators concluded: “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.”
Sandhya Kalavacherla, BS, of the University of California San Diego School of Medicine, La Jolla, is the corresponding author of the JAMA Network Open article.
Disclosure: This study was supported by a grant from the 2022 Urology Care Foundation Research Scholar Award Program and by a grant from Bristol Myers Squibb.
