Racial Disparities in PSA Screening and Referral to Urology in a Large, Integrated Healthcare System: A Retrospective Cohort Study

J Urol. 2021 Apr 1:101097JU0000000000001763. doi: 10.1097/JU.0000000000001763. Online ahead of print.


PURPOSE: Contemporary trends and racial disparities in prostate cancer screening and referral to urology for prostate cancer (PCa) risk are not well characterized, despite consensus that Black men are at higher risk for poor PCa outcomes. The objective of this study was to characterize current racial disparities in PCa screening and referral from primary care to urology for PCa concern within our large, integrated healthcare system.

MATERIALS AND METHODS: This retrospective cohort study used data from Atrium Health’s enterprise data warehouse, which includes patient information from over 900 care locations across North Carolina, South Carolina, and Georgia. We included all men seen in the ambulatory or outpatient setting between 2014-2019 who were ≥40 years old. Clinical and demographic data were collected for all men, including age and race. Racial outcomes were reported for all groups with >2% representation in the population. Between-group comparisons were determined using chi-squared analysis, Wilcoxon rank sum testing, and multivariable logistic regression, with significance defined as p <0.05.

RESULTS: We observed a significant decrease in PSA testing across all age and racial groups in a cohort of 606,985 men at Atrium Health, including 87,189 Black men, with an overall relative decline of 56%. As compared to white men, Black men were more likely to undergo PSA testing (adjusted O.R. 1.24, 95% C.I.: 1.22-1.26) and be referred to urology for PCa (adjusted O.R. 1.94, 95% C.I.: 1.75-2.16).

CONCLUSIONS: There was a continued significant decline in prostate cancer screening between 2014 and 2019. Despite having modestly elevated odds of being screened for prostate cancer compared to white men, Black men are relatively under-screened when considering that those who undergo PSA screening are more likely to be referred by primary care to urology for additional prostate cancer diagnostic evaluation.

PMID:33793294 | DOI:10.1097/JU.0000000000001763