Changes in PSA-Based Early Detection of Prostate Cancer over a 12-Year Period: Findings from the German KABOT Study

Background: The effectiveness of prostate-specific antigen (PSA)-based early detection of prostate cancer remains controversial and implementation-dependent. Screening policy changes have substantially altered PSA testing behavior in the United States, yet longitudinal evidence from non-organized European settings is limited. We assessed 12-year changes in awareness and utilization of PSA-based early detection and identified subgroups requiring targeted counseling. Methods: Two cross-sectional survey waves were conducted in 2009 (Study Phase 1) and 2021 (Study Phase 2) among men recruited via general practitioner practices in urban and rural regions of Germany. The survey was developed and reported according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Identical questionnaires were used across phases. Endpoints were awareness of PSA-based early detection and prior PSA testing. Univariable and multivariable logistic regression evaluated independent associations with sociodemographic and behavioral factors. To assess sensitivity to compositional differences between survey waves, post-stratified weighted analyses re-aligning Study Phase 2 to the Study Phase 1 distribution of age category, educational attainment, and smoking status were conducted. Results: The analytic cohort comprised 890 men (Study Phase 1, n = 755; Study Phase 2, n = 135). Compared with Study Phase 1, Study Phase 2 participants more frequently were non-smokers (63.0% vs. 48.5%, p < 0.001) and had a university degree (38.5% vs. 30.5%, p = 0.002). In primary multivariable analyses, higher educational attainment (OR 1.71, 95% CI 1.24-2.36) and paternity (OR 1.94, 95% CI 1.25-3.01) were independently associated with greater awareness, whereas increasing age (OR 1.39, 95% CI 1.29-1.50) and higher educational attainment (OR 1.63, 95% CI 1.19-2.24) were independently associated with utilization. Study phase was not independently associated with either endpoint in primary models. In post-stratified sensitivity analyses, study phase was positively associated with utilization, indicating sensitivity of temporal contrasts to population composition. Conclusions: In primary multivariable analyses, we did not detect statistically significant temporal differences in awareness or utilization of PSA-based early detection within this German non-organized setting. The emergence of a study phase effect in weighted sensitivity analyses suggests that apparent time trends may be influenced by compositional differences between survey waves. Persistent social gradients, particularly related to educational attainment, underscore the importance of targeted, evidence-based counseling in opportunistic early detection systems. Larger, prospectively designed studies are needed to distinguish true temporal change from sampling-related effects.