Background
Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients.
Methods
We identified African American men aged 40–55, diagnosed with prostate cancer between 2004–2017 within the Veterans Health Administration. Inverse probability of treatment weighted propensity scores were utilized in multivariable models to assess PSA screening on PSA > 20, Gleason score ≥ 8, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on PCSM, with non-cancer death as competing events. All statistical tests were 2-sided.
Results
The cohort included 4,726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1,057 (22.4%) with no PSA screening prior to diagnosis. Compared to no screening, PSA screening was associated with statistically significantly reduced odds of PSA > 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49–0.63, P < .001), Gleason score ≥ 8 (OR = 0.78, 95% CI = 0.69–0.88, P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39–0.64, P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36–0.76, P < .001). Primary care provider visits displayed similar effects.
Conclusions
Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA > 20, Gleason score ≥ 8, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.