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PSA screening is on the rise and varies according to age, family history, race/ethnicity, and insurance status.
Undertaken by researchers at the University of North Carolina, Chapel Hill and presented at the American Society of Clinical Oncology annual meeting in Chicago, the study investigated patterns of PSA screening and outcomes using data from 3,763 men 40 years of age and older who participated in the National Health and Nutrition Examination Survey for the years 2003 to 2008. It found that the proportion of men self reporting prior PSA screening increased over the 6-year study period. Overall, the majority of men 50 years of age and older had a history of PSA screening, and the rate rose with increasing age, from 54% among men 50 to 59 years of age to 81% for the 70+ age group.
Screening rates also differed significantly depending on whether men had a positive or negative family history of prostate cancer (69% vs. 49%), were Caucasian or non-Caucasian (55% vs. 40%), and had health insurance or not (56% vs. 26%), and they rose with increasing levels of household income and education.
Increasing age predictive of high PSA
To investigate the potential benefit of screening, logistic regression analyses were conducted assessing whether screening status, age, race/ethnicity, and family history of prostate cancer were predictive of a high PSA level (defined as ≥10.0 ng/mL). Of the four variables, only increasing age was associated with a significantly increased risk of having a high PSA outcome.
Senior author Ronald C. Chen, MD, MPH, told Urology Times that while the latter findings must be interpreted with caution considering it was not possible to distinguish regular, annual screening from one-time screening, they do not clearly support a benefit for screening.
"Our hypothesis was that the screened men would have lower PSA values than their unscreened counterparts, assuming that screening would remove patients with prostate cancer from the cohort. We did not find this, even in subgroups of men with high risk of developing prostate cancer, such as those with a family history. Perhaps we would have found a difference if we had been able to compare never-screened high-risk men with regular-annually screened high-risk men," said Dr. Chen, assistant professor of radiation oncology at the University of North Carolina Comprehensive Cancer Center.
"However, the study findings underscore the need to develop better tools than PSA testing to screen for prostate cancer."
Allen noted the study has additional limitations because the data are from a cross-sectional survey. Information about PSA screening is based on self-reports, and details about the extent and results of the screening are unknown.
"Ideally, a randomized controlled trial enrolling high-risk patients and looking at mortality as the endpoint would be needed to conclusively determine whether or not there is a benefit for PSA screening in these subgroups of men," Allen said.