PSA Screening Rates and Incidence of Metastatic Prostate Cancer at VHA Facilities

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In a retrospective cohort study reported in JAMA Oncology, Bryant et al found that prostate-specific antigen (PSA) screening rates at Veterans Health Administration (VHA) facilities declined between 2005 and 2019—and that diagnoses of metastatic prostate cancer increased over the same time period.

Study Details

The study used data from patients aged ≥ 40 years with an encounter at 128 facilities in the VHA between January 2005 and December 2019. Facility-level screening rates were defined as the proportion of patients with a PSA test in each year, and long-term nonscreening rates were defined as the proportion without a PSA test in the prior 3 years.

The main outcome measures were facility-level yearly counts of incident metastatic prostate cancer diagnoses, and age-adjusted yearly metastatic prostate cancer incidence rates 5 years after each PSA screening exposure year.

Key Findings

The cohort included 4,678,412 patients in 2005 and 5,371,701 in 2019.

PSA screening rates decreased from 47.2% in 2005 to 37.0% in 2019; metastatic prostate cancer incidence increased from 5.2 cases per 100,000 patients in 2005 to 7.9 cases per 100,000 patients 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% confidence interval [CI] = 0.87–0.96, P < .001). Higher long-term nonscreening rates were associated with higher metastatic disease incidence 5 years later (IRR = 1.11 per 10% increase in long-term nonscreening rate, 95% CI = 1.03–1.19, P = .01).

The investigators concluded, “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 [patients] who wish to reduce their risk of metastatic prostate cancer.”

Brent S. Rose, MD, MAS, of the Department of Radiation Medicine and Applied Sciences, the University of California, San Diego, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the Department of Veterans Affairs Informatics and Computing Infrastructure. For full disclosures of the study authors, visit

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