Older Men Still Overscreened for Prostate Cancer, Survey Says

Older men are being overscreened for prostate cancer, despite U.S. Preventive Services Task Force (USPSTF) guidelines against prostate-specific antigen (PSA) testing in men ages 70 and up, a survey study showed.

Among a cohort of over 30,000 men, recent PSA screening rates were 55.3% for men ages 70 to 74, 52.1% for those ages 75 to 79, and 39.4% for those ages 80 and older, reported Sandhya Kalavacherla, BS, of the University of California San Diego School of Medicine in La Jolla, and colleagues in JAMA Network Open.

Of note, discussing PSA testing advantages with a clinician was associated with increased recent screening (OR 9.09, 95% CI 7.60-11.40), whereas discussing PSA testing disadvantages had no association with screening (OR 0.95, 95% CI 0.77-1.17).

This suggests "that any discussion of PSA testing likely occurs in the context of a clinician- or patient-initiated effort to ultimately screen for prostate cancer," Kalavacherla and colleagues wrote.

Other factors associated with increased screening in older men included having:

• A primary care provider (OR 1.89, 95% CI 1.41-2.53)
• An annual income of $25,000 to $50,000 (OR 1.39, 95% CI 1.10-1.75), or more than $50,000 (OR 1.36, 95% CI 1.03-1.81) compared with an income less than $25,000
• A high school diploma or GED certificate (OR 1.46, 95% CI 1.07-2.00), some college (OR 1.79, 95% CI 1.32-2.43), or a college degree (OR 1.93, 95% CI 1.40-2.66), compared with no high school diploma or attendance

"The results of this study can inform interventions to disincentivize low-value screening," the authors concluded. "For instance, given the higher educational levels among respondents who may overuse PSA screening, direct patient education on the risks of PSA screening may be beneficial for males older than 70 years. Future work should quantify the implications of this screening, specifically the consequences of overtreatment for patients."

This survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the CDC. The study cohort included 32,306 men. Most were white (87.6%), 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic. Within this cohort, 42.8% were 70 to 74 years old, 28.4% were 75 to 79, and 28.9% were 80 or older. Most respondents were retired, had a college degree, and were never smokers.

White men had the highest screening rate (50.7%), and American Indian men had the lowest screening rate (32.0%).

Compared with married men, those who were divorced, widowed, or separated were less likely to be recently screened. Employment status, smoking status, and cost barriers were not associated with recent screening.

There are several limitations to the study, including the fact that the 2020 BRFSS had a response rate of just 47.9%, and some states did not offer a prostate cancer module associated with the survey. This potentially introduced selection bias and limited generalizability, Kalavacherla and team acknowledged, adding that the issue was "further compounded by the PSA screening module being optional in the survey, potentially creating sampling bias."

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