As PSA Screening Rates Declined, Metastatic Prostate Cancer Rates Increased in VHA

A study presented at the American Society for Radiation Oncology (ASTRO) 2022 Annual Meeting found that a drop in PSA screening rates is associated with higher subsequent rates of metastatic prostate cancer (mPCa).

The researchers used data from the United States Veterans Healthcare Administration (VHA) to calculate yearly PSA screening rates, long-term non-screening rates (no PSA measured in prior three years), and age-adjusted mPCa incidence rates from 2005 to 2019. Since 2008, PSA screening rates have declined and the rate for mPCa has risen; however, no direct epidemiologic evidence correlating has been previously reported.

The cohort included 4.7 million men in 2005, which increased to 5.4 million in 2019, in 128 VHA facilities. Random effects linear regression was usedto examine the influence of yearly facility-level PSA screening rates from 2010-2013 on subsequent facility-level mPCa incidence from 2014-2019. Rates were reported per 100,000 men and aggregated by race, age group and facility.

The study found PSA screening rates declined from a high of 50.8% in 2008 to 37% in 2019 while mPCa incidence increased from a low of 4.6 in 2008 to 7.9 in 2019, driven by increases in the 55-69 and 70+ year old age groups. Lower facility-level PSA screening rates were associated with higher subsequent mPCa incidence (0.87 unit increase in 2014-2019 mPCa incidence rate per 10% decrease in 2010-2013 PSA screening rate, 95% confidence interval [CI] 0.58 to 1.15, p<0.001). Similarly, higher long-term non-screening rates were associated with higher subsequent mPCa incidence (1.61 unit increase in 2014-2019 mPCa incidence rate per 10% increase in 2010-2013 long-term non-screening rate, 95% CI 1.14 to 2.08, p<0.001).

The authors conclude the 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.