Racial and Ethnic Variation in PSA Testing and Prostate Cancer Incidence Following the 2012 USPSTF Recommendation

Abstract

Background: The 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race and ethnicity remains unclear.

Methods: The proportion of 40- to 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 (2012-2018). Odds ratios (ORs) of undergoing screening by race and ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race and ethnicity were estimated using Surveillance, Epidemiology, and End Results registry data (2004-2017).

Results: PSA testing frequencies were 32.3% (95% confidence interval [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 and 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 = .005), driven by a larger decline among NHB men ages 40-54 years. The NHB to 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 and ethnic groups.

Conclusions: The frequency of prostate cancer screening varies by race and ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB to NHW IRR for localized prostate cancer modestly increased following 2012.

Figure 1.

Trends in prostate-specific antigen (PSA) testing in the total US population and by race and ethnicity from 2012 to 2018. The proportion of men who self-reported undergoing a screening PSA test in the prior year over time in the Behavioral Risk Factor Surveillance System (A) in the total population among men aged 40-74 years, (B) by race and ethnicity among men aged 40-74 years, (C) in the total population among men aged 40-54 years, (D) by race and ethnicity among men aged 40-54 years, (E) in the total population among men aged 55-69 years, and (F) by race and ethnicity among men aged 55-69 years. Dashed lines indicate the publication of draft prostate cancer screening recommendations by the US Preventive Services Task Force. NHAIAN = Non-Hispanic American Indian and Alaska Native; NHAPI = Non-Hispanic Asian and Pacific Islander; NHB = Non-Hispanic Black; NHW = Non-Hispanic White.

Figure 2.

Prostate cancer  incidence by race and ethnicity among men aged 40-74 years from 2004 to 2017 in the Surveillance, Epidemiology, and End Results-21 registries. (A) Age-standardized total prostate cancer incidence rates and joinpoint regression lines by race and ethnicity, (B) age-standardized total prostate cancer incidence rate ratios comparing racial and ethnic groups with NHW men, (C), age-standardized stage-specific prostate cancer incidence rates and joinpoint regression lines by race and ethnicity, (D) age-standardized stage-specific prostate cancer incidence rate ratios comparing racial and ethnic groups with NHW men. Dashed lines indicate the publication of draft prostate cancer screening recommendations by the US Preventive Services Task Force. NHAIAN = Non-Hispanic American Indian and Alaska Native; NHAPI = Non-Hispanic Asian and Pacific Islander; NHB = Non-Hispanic Black; NHW = Non-Hispanic White.