Exploring prostate-specific antigen (PSA) Testing rates and screening disparities in the all of us dataset

To examine prostate cancer (PCa) screening disparities among ethnic groups in the U.S. using the All of Us database.

White, Black, Hispanic, and Asian males ≥ 40 years old were included, excluding diagnosis's that conflict with PCa screening. We analyzed prostate-specific antigen (PSA) screening rates by age based on American Urological Association guidelines, using multivariable logistic regression (MLR) and a Cox time-to-event models that considered race, age, income, education, insurance, and home ownership as independent variables. Initial screening ages and biopsy rates were also compared.

Of 56,473 individuals, 18,088 had PSA measurements: 74% White, 15% Black, 9% Hispanic, and 2% Asian. Hispanic (20%) and Black (21%) minorities were less likely to undergo PSA screening compared to White men (39%, P < 0.001). However, minorities had their initial PSA earlier with their first test from 53-54 years old compared to White men at 58 years (P < 0.001). MLR revealed race, age, income, education, insurance type, and home ownership as screening predictors (P < 0.001). Screened Black men had higher odds of an elevated PSA (P < 0.001), but the likelihood of receiving a biopsy postelevated PSA did not significantly differ from White men (P = 0.821). Additionally, those screened at age ≥ 70 were more likely to be White, have at least a college education, and be homeowners (P < 0.001).

White men, despite starting at a later age, are screened with PSAs more frequently than minorities, and often undergo screening at older ages outside the recommended guidelines. Black men did not have a higher rate of biopsy after having an elevated PSA compared to White men.