Research Frontiers Say important things three times! The key to preventing and treating prostate cancer is early screening! Early screening! Early screening!

What is the association between prostate-specific antigen screening rates and the incidence of metastatic prostate cancer? This article published recently in JAMA may answer this question
.

The benefits of prostate-specific antigen (PSA) screening remain controversial
.
Since 2008, PSA screening rates in the United States have declined, while the incidence of metastatic prostate cancer (mPC) has increased
.
However, there is no direct epidemiological evidence of a correlation
between population PSA screening rates and subsequent mPC incidence.
The study retrospectively analyzed data from all aged ≥40-year-old men attending 128 healthcare facilities by the U.
S.
Veterans Health Administration (VHA) to assess whether PSA screening rates at healthcare facilities were associated
with subsequent mPC incidence.

The retrospective cohort included data
for all aged ≥ 40-year-old men in 128 healthcare facilities of VHA between 1 January 2005 and 31 December 2019.
The exposure factor, i.
e.
, the rate of PSA screening at a healthcare facility, is defined as the number of patients screened for PSA at a VHA facility each year divided by the number of male patients who received any treatment at a VHA facility in the current year; The long-term non-screening rate is defined as the proportion
of patients who have not been screened for PSA within 3 years to all male patients who visit each year.
The incidence of mCP is defined as the number of patients who develop prostate cancer each year divided by the number of
male patients who received any treatment at the VHA facility that year.
Primary outcomes were annual mPC diagnoses and age-standardized incidence (per 100,000 men)
per 5 years after PSA screening in VHA settings.

The VHA cohort included 4678412 male patients in 2005 and increased to 5371701 male patients
in 2019.
The screening rate for PSA decreased from 47.
2% (2005) to 37.
0% (2019) and the age-standardized incidence of mPC increased from 5.
2 per 100,000 (2005) to 7.
9 per 100,000 (2019).

Table 1 Annual number of mPC diagnoses and age-standardized incidence

The results of statistical analysis showed that higher PSA screening rate was associated with lower incidence of mPC after 5 years, with an incidence ratio (IRR) of 0.
91 (95% CI, 0.
87-0.
96; P<0.
001) for each 10% increase in PSA screening rate, and a higher long-term non-screening rate was associated with a higher incidence of mPC after 5 years, with an IRR of 1.
11 (95% CI, 1.
03-1.
19; P=0.
01)<b10> for each 10% increase in long-term non-screening rate.

 Fig.
1 Relationship between PSA screening rate (a) and long-term non-screening rate (b) and subsequent mPC incidence

In summary, the PSA screening rate of VHA medical institutions was inversely correlated with the subsequent incidence of mPC
.
This result confirms the potential benefit
of screening for PSA in men aged ≥ 40 years.

References:

BryantAK , Lee KM, Alba PR, Murphy JD, Martinez ME, Natarajan L, Green MD, Dess RT, Anglin-Foote TR, Robison B, DuVall SL, Lynch JA, Rose BS.
Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities.
JAMA Oncol.
2022 Oct 24:e224319.