Prostate-Specific Antigen Screening Patterns and Metastatic Prostate Cancer in US Veterans

What are the associations of age at prostate-specific antigen (PSA) screening initiation, testing interval, and baseline PSA value with metastatic prostate cancer rates?In this cohort study of 103 067 male veterans, older age at screening start (≥60 vs <50 years) and higher baseline PSA value (>4 vs ≤1 ng/mL) were associated with 2.4-fold and 6.7-fold higher rate of metastatic prostate cancer at diagnosis, respectively, with smaller associations with testing interval. Strategies combining younger ages and baseline PSA values were associated with lower rates of metastatic presentation, particularly in Black individuals.These findings suggest that in high-risk populations such as male veterans, optimizing screening based on age at screening start and baseline PSA may reduce metastatic presentation.

Corresponding Author: Isla P. Garraway, MD, PhD, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 10833 Le Conte Ave, PO Box 951738 CHS, Los Angeles, CA 90095 (igarraway@mednet.ucla.edu).

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