Background
The 2012 US Preventive Services Task Force (USPSTF) recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race/ethnicity remains unclear.
Methods
The proportion of 40–74 year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (BRFSS; 2012–2018). Odds ratios (ORs) of undergoing screening by race/ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated using Surveillance, Epidemiology and End Results registry data (2004–2017).
Results
PSA testing frequencies were 32.3% (95% CI = 31.7 to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3 to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9 to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1 to 21.3%) among Asian/Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity =0.005), driven by a larger decline among NHB men ages 40–54 y. The NHB: NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial/ethnic groups.
Conclusions
The frequency of prostate cancer screening varies by race/ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB: NHW IRR for localized prostate cancer modestly increased following 2012.