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Sandy Srinivas, MD


VA Study Addresses the Impact of PSA Screening on Subsequent Metastatic Prostate Cancer

By: Celeste L. Dixon
Posted: Monday, January 23, 2023

Higher rates of screening for prostate cancer with prostate-specific antigen (PSA) measurement resulted in lower subsequent rates of metastatic prostate cancer 5 years later (P  < .001), according to the results of a retrospective cohort study involving millions of men aged 40 and older who visited 128 U.S. Veterans Health Administration (VA) facilities between 2005 and 2019. Conversely, higher long-term nonscreening rates were associated with higher metastatic prostate cancer incidence 5 years later (P  =  .01), reported Brent S. Rose, MD, of University of California, San Diego, and colleagues in JAMA Oncology.

The benefit of widespread PSA screening has been controversial, the authors noted, adding that PSA screening rates in the United States have decreased since 2008. The data the investigators presented “may be used to inform shared decision-making about the potential benefits of PSA screening among men who wish to reduce their risk of metastatic prostate cancer,” wrote Dr. Rose and co-investigators.

In VA facilities, they noted, PSA screening rates decreased from 47.2% in 2005 to 37.0% in 2019, and metastatic prostate cancer incidence increased from 5.2 per 100,000 men in 2005 to 7.9 per 100,000 men in 2019. Facilities with higher yearly PSA screening rates—defined as the proportion of men aged 40 or older with a PSA test in each year—had lower subsequent rates of metastatic prostate cancer, they reiterated. The long-term nonscreening rate was defined as the proportion of men aged 40 or older without a PSA test in the prior 3 years.

The study’s main outcomes were facility-level yearly counts of incident metastatic prostate cancer diagnoses (2010–2019) and age-adjusted yearly metastatic prostate cancer incidence rates (per 100,000 men) 5 years after each PSA screening exposure year (2005–2014). The number of patients in the cohort varied by year; it included 4,678,412 men in 2005 and 5,371,701 men in 2019. Data related to the incidence of nonmetastatic prostate cancer were less conclusive.

Disclosure: The study authors’ disclosure information can be found at

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