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Sandy Srinivas, MD


ASTRO 2022: Is There a Correlation Between PSA Screening and Subsequent Metastatic Prostate Cancer?

By: Lauren Velentzas
Posted: Friday, November 4, 2022

The benefit of prostate-specific antigen (PSA) screening for prostate cancer has been controversial since the changing of practice guidelines in 2008. The incidence of metastatic prostate cancer has risen, and Alex K. Bryant, MD, MS, of the University of Michigan, Ann Arbor, and colleagues conducted a study to discover whether there is a correlation between population PSA screening rates and the incidence of metastatic prostate cancer. The findings of the study were presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 298).

“This study provides evidence that facilities that are more intensively screening men may be reducing the risk of metastatic prostate cancer later,” stated the investigators.

Using data from the U.S. Veterans Healthcare Administration (VHA), the investigators focused on a cohort of 4.7 million to 5.4 million male patients from 2005 to 2019 across 128 VHA centers. Incident rates of metastatic cancer were reported per 100,000 men and were aggregated by race, age group, and VHA facility.

It was found that PSA screening rates declined in all age and race groups from 47% in 2005 to 37% in 2019, with a high of 50.8% in 2008. The incidence of metastatic prostate cancer increased from a low of 4.6 in 2008 to 7.9 in 2019, which was driven by increases in the 55-to-69 and over-70 age groups. Lower facility-level PSA screening rates resulted in higher subsequent rates of metastatic prostate cancer; the incidence increased by 10% for every 10% decrease in screening (incidence rate ratio = 1.10, 95% confidence interval [CI] = 1.04–1.15, P < .001). Similarly, facilities with higher long-term nonscreening rates were associated with a higher subsequent incidence of metastatic prostate cancer (95% CI = 1.14–2.08, P < .001).

Disclosure: For Dr. Bryant’s disclosure information, visit

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