Acquired and Congenital Spinal Cord Injury is Associated With Lower Likelihood of Prostate Specific Antigen Screening

To evaluate prostate cancer screening occurrence in patients with spinal cord injury at our institution compared to a matched, unaffected population.

We conducted a retrospective review of patients with the criteria: male, age 50-70, and diagnosis of cerebral palsy, spina bifida, or quadriplegia. A control cohort was matched by age, race, insurance, and co-morbidities. Prostate specific antigen (PSA) screening, PSA value, prostate MRI, prostate biopsy, and biopsy outcome were compared. Multivariate logistic regression analysis was performed to determine the association between patient variables and PSA screening.

The study cohort and control cohort included 2180 patients each. Patients with spinal cord injury had significantly lower rates of PSA screening (15% vs 24%, P <.00001), MRI (0.1% vs 0.6%, P = .02), and biopsy (0.6% vs 1.3%, P = .01) compared to control. Spinal cord injury was associated with a lower likelihood of PSA screening (OR = 0.56, CI = 0.48-0.65, P <.00001). There were no significant differences in PSA value and biopsy outcomes.

Patients with spinal cord injury had a lower likelihood of PSA screening compared to a matched control population. Since PSA screening is a shared-decision making process, providers should consider the increasing life expectancy of patients with spinal cord injury and risks of under-testing for prostate cancer.