To evaluate contemporary PSA screening practices and their association with metastatic prostate cancer at diagnosis in veterans.
Approach:
Study Population: The study evaluated 103,067 veterans who received a prostate needle biopsy between 2015 and 2023 at the Veterans Health Administration.
Factors Examined: Factors included age at first PSA, first PSA value, and the longest interval between PSA tests in the 5 years prior to biopsy.
Analysis Method: Multivariable analyses were conducted to assess the association of screening practices with metastatic prostate cancer diagnosis.
Key Findings:
Initiating screening at younger than 50 years, a first PSA value of 1 ng/mL or less, and a screening interval of 24 months or less were associated with a reduced risk of metastatic prostate cancer.
The association with metastatic disease was primarily influenced by the first PSA value.
Increased age and longer intervals between PSA tests were linked to a higher risk of metastatic disease.
Interpretation:
The findings suggest that PSA screening can prevent metastatic disease, advocating for earlier initiation and more frequent screening.
Limitations:
The study does not address the optimal age for screening initiation.
Potential harms of overdetection and overtreatment were not fully explored.
Conclusion:
The study highlights the need for shared decision-making in prostate cancer screening, while acknowledging barriers to implementation.
