Prosteria - National Trends and Outcomes of More Frequent Than Guideline Recommended Prostate Specific Antigen Screening

Abstract

Objective: To characterize national trends in and associated outcomes of more often than annual prostate-specific antigen (PSA) screening, which we term "prosteria."

Methods: Men in the Optum Clinformatics Data Mart with ≥2 years from first PSA test to censoring at the end of insurance or available data (January 2003 to June 2019) or following exclusionary diagnoses or procedures, such as PCa treatment, were included. PSAs within 90 days were treated as one PSA. Prosteria was defined as having ≥3 PSA testing intervals of ≤270 days.

Results: A total of 9,734,077 PSAs on 2,958,923 men were included. The average inter-PSA testing interval was 1.5 years, and 4.5% of men had prosteria, which increased by 0.53% per year. Educated, wealthy, non-White patients were more likely to have prosteria. Men within the recommended screening age (ie 55-69) had lower rates of prosteria. Prosteria patients had higher average PSA values (2.5 vs 1.4 ng/mL), but lower values at PCa diagnosis. Prosteria was associated with biopsy and PCa diagnosis; however, there were comparable rates of treatment within 2 years of diagnosis.

Conclusion: In this large cohort study, prosteria was common, increased over time, and was associated with demographic characteristics. Importantly, there were no clinically meaningful differences in PSA values at diagnosis or rates of early treatment, suggesting prosteria leads to both overdiagnosis and overtreatment. These results support current AUA and USPTF guidelines and can be used to counsel men seeking more frequent PSA screening.

Figure 1:. Temporal Trends in Prosteria

Distribution of PSA over the study period. 2003–2017 are displayed as there was a subsequent drop in cohort size due to patients needing 2 years of continuous enrollment with data terminating in 2019. Gray: Total PSA tests, normalized by 100,000 male enrollees at that time. Orange: Normalized number of PSA tests on patients with prosteria. Blue: Percent of PSAs on patients with prosteria. Red: Trend line for proportion of PSAs on patients with prosteria, weighted by number of PSA tests per month.

Figure 2:. Survival Analyses

Panel A and B: Kaplan-Meier survival curves for prostate biopsy and PCa diagnosis since first PSA test, stratified by prosteria. Panel D-F: Survival curves for prostatectomy, radiation, hormone therapy, and any treatment from time of PCa diagnosis, stratified by prosteria.