Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020

Abstract

Background United States Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening in 2012, which was modified into shared decision making for men aged 55-70 with life expectancy over 10 years in 2018. We studied the trends in PSA screening in younger Black and White men with the implementation of 2012 and 2018 guidelines. Methods Younger Black and White men (aged 40-54 years) were identified using Behavioral Risk Factor Surveillance System database biennially from 2012 to 2020. Our primary outcome was PSA screening within two years of the survey. An adjusted logistic regression model with two-way interaction assessment between race and survey year was used to investigate the temporal trend of PSA screening in younger Black and White men. Results A total of 142,892 men were included. We saw steadily decreasing odds of PSA screening among both younger Black and White men in 2014, 2016, 2018, and 2020 compared to 2012 (for younger Black men: OR2014=0.77 [95%CI=0.62, 0.96], OR2016=0.51 [95%CI=0.41, 0.63], OR2018=0.33 [95%CI=0.27, 0.42], OR2020=0.25 [95%CI=0.18, 0.32]; and for younger White men: OR2014=0.81 [95%CI=0.76, 0.87], OR2016=0.66 [95%CI=0.61, 0.71], OR2018=0.41 [95%CI=0.37, 0.44], OR2020=0.36 [95%CI=0.33, 0.39]). Younger Black men showed brisker decrease in PSA screening in year 2016, 2018, and 2020 compared to younger White men (all p < 0.05). Conclusions PSA screening among younger men steadily decreased over the past decade since 2012 USPSTF guidelines, demonstrating a narrowing racial gap. How such observed trend translates to long-term clinical outcomes for younger Black men remains to be seen.

Racial differences in postpandemic trends in prostate-specific antigen screening

“…However, the strength of our study stemmed from our use of the largest continuous health survey maintained by the Centers for Disease Control and Prevention, leading to a diverse population with robust statistical power. Although there are some small differences in screening rates compared with other national surveys like the National Health Interview Survey, our findings align with historical BRFSS data, emphasizing the reliability of our analysis ( 10 ). This underscores the value of considering different survey methodologies and demographic samples in health research.…”

Incidence trends in prostate cancer among men in the United States from 2000 to 2020 by race and ethnicity, age and tumor stage

“…While the increasing trend in prostate cancer incidence in the early 1990s was most likely due to widespread use of prostate-specific antigen screening that led to case surge in detecting men with asymptomatic prostate cancer, the decreasing trend in 1991-2013 was most likely due to the reduced number of early (local) stage prostate cancer through PSA screening ( 1 ). However, the incidence of prostate cancer increased from 2014 to 2019, which was most likely due to the screening guideline in which the United States Preventive Services Task Force (USPSTF) recommended against screening for men aged 75 years and older in 2008 and for all men in 2012 ( 13 – 17 ). The drop in 2020 for the incidence of prostate cancer was observed in the most recent data, which was most likely due to the impact of COVID-19 pandemic lockdown or restriction to medical facilities that substantially reduced the number of people going for regular cancer screening or medical visits for suspicious symptoms related to prostate diseases ( 23 – 26 ).…”

“…About half of these additional prostate cancer cases that occurred were found at an advanced tumor stage ( 1 ). This phenomenon happened likely because the United States Preventive Services Task Force (USPSTF) recommended against screening for men aged 75 years and older in 2008 and for all men in 2012 ( 13 – 17 ). Good news is that prostate cancer mortality has continued to decline ( 1 ).…”

Prostate-specific antigen testing rates in high-risk populations: results from the All of Us Research Program

“…However, the magnitude of the disparity between non-Hispanic Black and non-Hispanic White men in All of Us exceeded estimates from population-based surveys [ 5 ]. National estimates also suggest that non-Hispanic Black men ages 40–54 are more likely to be screened for prostate cancer than non-Hispanic White men in this age group, though the opposite association was observed in All of Us [ 26 ]. This suggests there may be under-ascertainment of PSA tests within the All of Us data, particularly among minoritized racial and ethnic populations.…”