RE: THE PROSTATE SPECIFIC ANTIGEN ERA IN THE UNITED STATES IS OVER FOR PROSTATE CANCER: WHAT HAPPENED IN THE LAST 20 YEARS?

40 Background: During the past decade, the incidence of prostate cancer in the United States has declined. We hypothesized this was related to lower rates of prostate-specific antigen (PSA) testing and sought to evaluate PSA testing rates nationally. Methods: Using the National Ambulatory Medical Care Survey, a nationally representative sample of outpatient visits in the United States, we analyzed rates of PSA testing in men age 40 years or older who visited PCPs or urologists from 1997 to 2008. Results: An estimated 26.6 million (95% CI: 24.8-28.4 million) PSA tests were ordered during 94.5 million (95% CI: 90.9-98.1 million) office visits to urologists and 95 million (95% CI: 87.5-102.8 million) tests were ordered during 1.17 billion (95% CI: 1.15-1.18 billion) visits to PCPs, with an annual increase of 3.4% and 6.0%, respectively (P=0.055 and P<0.001 for trend). After adjusting for year, race, ethnicity, region, insurance and provider type, testing by PCPs was more likely among older men and highest among men aged 60 to 69 years (reference: 40-49 years; OR 2.32, 95% CI: 1.88-2.85). Compared to men without a chronic medical condition, those with one chronic condition had greater odds of receiving a PSA test (OR 1.28, 95% CI: 1.08-1.52). Conclusions: Prostate cancer incidence has declined over the past decade despite increasing rates of office-based PSA testing by PCPs and urologists during the period. Increasing rates of PSA testing merit scrutiny, especially in men with limited life expectancies who are unlikely to benefit from screening.

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Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.18 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 18-18

Author(s):

Brandon Arvin Virgil Mahal ◽

Yu-Wei Chen ◽

Vinayak Muralidhar ◽

Amandeep R. Mahal ◽

Toni K. Choueiri ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Racial Disparities ◽

Prostate Specific Antigen ◽

Black Men ◽

Specific Antigen ◽

The United States ◽

Black Race ◽

Psa Screening ◽

Cancer Outcome

18 Background: In 2012, the United States Preventive Services Task Force (USPSTF) recommended against Prostate-Specific Antigen (PSA) screening, despite evidence that Black men are at a higher risk of prostate cancer-specific mortality (PCSM). We evaluated whether Black men of potentially screening-eligible age (55-69) are at a disproportionally high risk of poor outcomes. Methods: The SEER database was used to study 390,259 men diagnosed with prostate cancer in the United States between 2004-2011. Multivariable logistic regression modeled the association between Black race and stage of presentation, while Fine-Gray competing risks regression modeled the association between Black race and PCSM, both as a function of screening eligibility (age 55-69 vs not). Results: Black men were more likely to present with metastatic disease (adjusted odds ratio [AOR] 1.65; 1.58-1.72; P< 0.001) and were at a higher risk of PCSM (adjusted hazard ratio [AHR] 1.36; 1.27-1.46; P< 0.001) compared to Non-Black men. There were significant interactions between race and PSA-screening eligibility such that Black patients experienced more disproportionate rates of metastatic disease (AOR 1.76; 1.65-1.87 vs. 1.55; 1.47-1.65; Pinteraction< 0.001) and PCSM (AHR 1.53; 1.37-1.70 vs. 1.25; 1.14-1.37; Pinteraction= 0.01) in the potentially PSA-screening eligible group than in the group not eligible for screening. Conclusions: Racial disparities in prostate cancer outcome among Black men in are significantly worse in PSA-screening eligible populations. These results raise the possibility that Black men could be disproportionately impacted by recommendations to end PSA screening in the United States and suggest that Black race should inform clinical decisions on PSA screening.

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