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Divergent Trends in Prostate-specific Antigen Screening Prior to Testosterone Therapy in Younger vs Older Men Amidst

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Prostate-specific antigen (PSA) screening before testosterone replacement therapy (TTh) is low, especially for younger men. Rates varied by age and guideline era, highlighting a need for improved prostate cancer risk assessment.

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Area of Science:

  • Urology
  • Andrology
  • Men's Health

Background:

  • Prostate-specific antigen (PSA) screening is recommended before initiating testosterone replacement therapy (TTh).
  • Current screening rates and variations by demographic factors and guideline periods are not well-defined.

Purpose of the Study:

  • To evaluate PSA testing rates before TTh in men aged 40-69.
  • To examine differences in PSA testing based on age groups, race, and guideline eras (2009-2012 vs. 2013-2022).

Main Methods:

  • Retrospective cohort study using the TriNetX Research Network (2009-2022).
  • Included 74,463 men aged 40-69 receiving TTh for hypogonadism.
  • Propensity score matching was used to control for confounding variables.

Main Results:

  • Overall PSA screening rates before TTh were 12.2% for men aged 40-54 and 18.6% for men aged 55-69.
  • Screening rates did not differ significantly by race, though Black men aged 40-54 had higher odds of screening than White men.
  • Screening rates increased in the later guideline era (2013-2022) for men aged 55-69.

Conclusions:

  • PSA screening prior to TTh remains suboptimal, particularly in younger men and specific racial groups.
  • Shifting clinical guidelines may influence screening practices.
  • There is a critical need for enhanced education and targeted strategies to ensure adequate prostate cancer risk assessment before TTh initiation.