Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

Abstract

ImportanceThere is controversy about the benefit of prostate-specific antigen (PSA) screening. Prostate-specific antigen screening rates have decreased since 2008 in the US, and the incidence of metastatic prostate cancer has increased. However, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent metastatic prostate cancer rates.ObjectiveTo assess whether facility-level variation in PSA screening rates is associated with subsequent facility-level metastatic prostate cancer incidence.Design, Setting, and ParticipantsThis retrospective cohort used data for all men aged 40 years or older with an encounter at 128 facilities in the US Veterans Health Administration (VHA) from January 1, 2005, to December 31, 2019.ExposuresYearly facility-level PSA screening rates, defined as the proportion of men aged 40 years or older with a PSA test in each year, and long-term nonscreening rates, defined as the proportion of men aged 40 years or older without a PSA test in the prior 3 years, from January 1, 2005, to December 31, 2014.Main Outcomes and MeasuresThe main outcomes were facility-level yearly counts of incident metastatic prostate cancer diagnoses and age-adjusted yearly metastatic prostate cancer incidence rates (per 100 000 men) 5 years after each PSA screening exposure year.ResultsThe cohort included 4 678 412 men in 2005 and 5 371 701 men in 2019. Prostate-specific antigen screening rates decreased from 47.2% in 2005 to 37.0% in 2019, and metastatic prostate cancer incidence increased from 5.2 per 100 000 men in 2005 to 7.9 per 100 000 men 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% CI, 0.87-0.96; P < .001). Higher long-term nonscreening rates were associated with higher metastatic prostate cancer incidence 5 years later (IRR, 1.11 per 10% increase in long-term nonscreening rate; 95% CI, 1.03-1.19; P = .01).Conclusions and RelevanceFrom 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 men who wish to reduce their risk of metastatic prostate cancer.

Prostate Cancer in Transgender Women in the Veterans Affairs Health System, 2000-2022

“…This case series demonstrated that prostate cancer occurs in transgender women and is not as rare as published case reports might suggest. However, rates were lower than expected based on prior prostate cancer incidence estimates in cisgender male veterans . Using data from 2005 to 2019, the age-weighted cisgender mean number of cases was 331 per 100 000 in 2011 (median year of transgender identity entry in the VA).…”

“…However, rates were lower than expected based on prior prostate cancer incidence estimates in cisgender male veterans . Using data from 2005 to 2019, the age-weighted cisgender mean number of cases was 331 per 100 000 in 2011 (median year of transgender identity entry in the VA). Given estimates of 10 000 transgender women in the VA, 33 cases per year would be expected.…”

Development and Validation of MyProstateScore 2.0 to Detect Clinically Significant Prostate Cancer

“…[7][8][9] Based on this uncertain benefit-to-harm ratio, trends in practice away from screening have resulted in a rising incidence of incurable, metastatic prostate cancer for the first time in decades. 14,44 Despite a clinical capacity to detect and effectively treat prostate cancer that is uniquely high among prevalent malignancies, the lack of a practical, highly accurate, and well-defined diagnostic approach in men with elevated serum PSA has impeded progress against the disease, which remains a leading cause of morbidity and mortality worldwide. Ultimately, there is an extraordinary need for a reliable clinical test to reduce the harms associated with prostate cancer screening and preserve its known mortality benefits.…”

Preservation of Proteins in Human Plasma through Metal–Organic Framework Encapsulation

“…MOFs have shown great promise in a variety of applications including biomineralization, − encapsulation, − chemical sensors, − vaccines, , gas storage, catalysis, and small molecule drug delivery such as doxorubicin and methylprednisolone. − In the latter, zeolitic imidazolate framework (ZIF)-90 was found to be more efficient than ZIF-8 at delivery in vivo for methylprednisolone. MOFs also exhibit exceptional thermal stability and the long shelf life of precursor materials, which can be readily deployed in various resource-limited settings. − Their ability to readily encapsulate biomolecules and release drugs in response to various (bio)­chemical stimuli renders ZIFs, a class of MOFs, attractive for a wide range of biomedical applications. − In previous studies, we successfully encapsulated a wide range of proteins in urine and plasma using ZIF-8 as the encapsulate. − In those studies, we examined the MOF encapsulation of one biomarker at a time. Here, we not only extend these studies specifically to prostate-specific antigen (PSA) but also measure the ability of ZIF-8 (composed of a hydrophobic organic linker) and ZIF-90 (composed of a hydrophilic organic linker) to preserve a broad range of biomarker proteins in patient plasma for MOF-based biopreservation and eventual on-demand reconstitution and analysis.…”