Overall PSA Screening Declines, But Those with Extended Life Expectancy See Increased Uptake

While the rates of screening for prostate cancer have increased in the United States among men with a family history of the condition, only 1 in 4 men in the United States with a life expectancy of over 15 years receive prostate-specific antigen (PSA) screening for the disease, according to a study presented by Taylor Malchow, MD, of the Wright State University Boonshoft School of Medicine, at the 2022 American Urological Association Annual Meeting.

Dr. Malchow and colleagues noted that estimation of life expectancy is critical for evaluating the benefit of PSA screening for prostate cancer. There is currently a paucity of studies to date that have evaluated the role of PSA screening in individuals with extended life expectancy, particularly for men with a family history of prostate cancer.

In their study, Dr. Malchow and researchers evaluated the temporal trends in PSA screening in men with a life expectancy of less than 5 years to up to 10 years compared with men with a life expectancy of greater than 15 years with a family history of prostate cancer. Additionally, the investigators evaluated the relative contribution of life expectancy in PSA screening.

The study included men aged 40 years and older without a history of prostate cancer, all of whom received PSA screening from the National Health Institution Survey (NHIS) from 2000 through 2018. The previously validated Schonberg index was used to examine life expectancy in this cohort.

Study participants were stratified based on limited vs extended life expectancy and risk of prostate cancer. The association between life expectancy and PSA screening and the strength of covariates in predicting screening rates were evaluated in multivariable logistic regression models and dominance analyses, respectively.

The rates of PSA screening significantly declined, regardless of life expectancy, during the study period. However, rates of PSA screening significantly increased in men with extended life expectancy and a family history of prostate cancer, rising from 28.8% in 2000 to 44.1% in 2015. The investigators observed a non-significant decline in PSA screening in men with limited life expectancy during the study period.

No significant relationship existed between the survey year and life expectancy for PSA screening in individuals with a family history of prostate cancer (odds ratio = 1.11, p=0.5). Predictors of PSA screening included prior colonoscopy (54.7%), visit with a healthcare provider within the last year (29.2%), and marital status (12.5%).

According to the investigators, the “discussion of PSA screening should be individualized in the context of factors such as family history of prostate cancer and life expectancy, among other factors.