Prostate-specific antigen testing among young men: an opportunity to improve value

Abstract

Introduction: Prostate cancer screening using prostate-specific antigen (PSA) testing remains widespread. The prevalence of PSA testing in young men is unknown and may be an appropriate target for improving health care by decreasing low-value testing in this age group. The purpose of this study was to determine PSA testing rates in men younger than current guidelines support.

Materials and methods: Health Informational National Trends Surveys (HINTS) from 2011 to 2014 and 2017 were analyzed to establish the prevalence of PSA testing in young men and to evaluate the differences in testing rates based on race.

Results: The combined survey data included 5178 men, with 2393 reporting previous PSA screening. Of men ages 18-39, 7% recalled receipt of PSA testing. Twenty-two percent of men between the ages of 40 and 44 had been tested. Among men under age 40, PSA testing was more common among black men (14%) compared to white men (7%), Hispanics (6%), and men of Asian descent (8%). Logistic regression modeling demonstrates that black men under the age of 40 were more likely to undergo PSA testing than other racial or ethnic groups (odds ratio 2.14; 95% CI 1.17, 3.93).

Conclusions: Current guidelines do not recommend routine PSA testing in average-risk men under the age of 40. This study found that a significant number of young men are exposed to testing, with the greatest risk among black men. This suggests that there is an opportunity to improve the value of PSA testing by decreasing testing in young men.

Keywords: biomarkers; cancer education; clinical guidelines; prostate cancer; screening; urological oncology.