CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING FOLLOWING THE 2018 UNITED STATES PREVENTIVE SERVICES TASK FORCE GUIDELINES AND THROUGH THE COVID-19 PANDEMIC

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Urol Oncol

Abstract

Introduction: Prostate cancer, the second leading cause of male cancer death, raises debates on optimal screening strategies due to overtreatment risks. The USPSTF revised their recommendation in 2018, promoting shared decision-making for PSA screening among men aged 55-69. However, the COVID-19 outbreak could have decreased cancer screening utilization. Our study investigates the effects of these key events on PSA screening in the recommended age group. Methods: We analyzed NHIS database from selected years (2013, 2015, 2018, 2019, 2021) to track changes in PSA screening pre- and post-2018 guidelines and COVID-19. We studied men aged 55-69 and those over 69 (reference group). Those who reported PSA testing within the last year were considered screened. Adjusted odds ratios between PSA screening prevalence and demographic characteristics were estimated. We applied a Difference-in-Difference (DID) design for comparing changes between age groups, accounting for unmeasured time-invariant characteristics. Results: A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years (Figrue 1). From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95%CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%); PSA screening also decreased 0.8% among older men but did not reach significance (95%CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID=-2.3%, 95%CI, -6.5%, 1.9%). Conclusions: Our analysis, based on a large national survey, suggested that the 2018 USPSTF recommendations increased PSA screening among men aged 55-69 and those >69. Yet, COVID-19 reversed this trend. Future research should explore the long-term impacts of the 2018 USPSTF guidelines and the pandemic on prostate cancer screening and clinical outcomes.

Volume

42

First Page

S90

Last Page

S90

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