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Despite guidelines advising against prostate-specific antigen (PSA) screening for older men, many continue to receive it. Discussing PSA testing benefits with a doctor was linked to higher screening rates in men aged 70 and older.

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Area of Science:

  • Urology
  • Preventive Medicine
  • Public Health

Background:

  • US Preventive Services Task Force guidelines recommend against prostate-specific antigen (PSA) screening for prostate cancer in men over 69.
  • Despite these recommendations, low-value PSA screening remains prevalent in older male populations.
  • This practice carries risks of false-positive results and overdiagnosis of indolent prostate cancer.

Purpose of the Study:

  • To identify factors associated with the continuation of low-value PSA screening in men aged 70 years and older.
  • To understand the prevalence of PSA screening in this demographic despite guideline recommendations.

Main Methods:

  • Utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey.
  • Included male respondents aged 70 years or older, excluding those with a prior prostate cancer diagnosis.
  • Employed weighted multivariable logistic regressions to analyze factors associated with recent PSA screening (within 2 years).

Main Results:

  • The study cohort included 32,306 males aged 70+.
  • Recent PSA screening rates were 55.3% (70-74 yrs), 52.1% (75-79 yrs), and 39.4% (80+ yrs).
  • Discussing PSA testing advantages with a clinician significantly increased screening odds (OR, 9.09; P<.001). Higher education, income, and having a primary care physician were also associated with increased screening.

Conclusions:

  • Older men in the US are frequently overscreened for prostate cancer, contrary to established guidelines.
  • Clinician communication regarding PSA testing benefits is a key driver of continued screening.
  • Interventions focused on clinician-patient discussions about PSA testing benefits may help reduce overscreening in older men.