Prostate Cancer Screening Practices Among High-Risk Patients: A Retrospective Analysis

Abstract

Prostate cancer is the second most common cancer in U.S. men, with higher incidence and mortality among African Americans and those with genetic or familial risk. Despite guidelines promoting early detection, prostate-specific antigen (PSA) screening in primary care remains inconsistent. We assessed PSA screening patterns and the association between risk factors and testing.A retrospective analysis was conducted on men aged ≥40 seen at primary care clinics from 2020 to 2022. Risk scores were created based on the number of prostate cancer risk factors. Univariate and multivariate analyses assessed associations between the risk scores, PSA screening, and cancer diagnosis. Of 176,326 patients, 31.4% underwent PSA testing, rising to 78.1% with a risk score of 4. The predictive model was significant (χ² = 19,527.021, df = 11, p < .001). PSA testing odds were higher with Medicaid or commercial insurance (vs. Medicare) and lower for self-pay patients. Former and never smokers were more likely to be tested than current smokers. Age, African American race, and family history increased the odds of receiving PSA testing. Prostate cancer diagnosis reached 25% at a risk score of 5, with significant predictors including older age, African American race, family history, and mention of "prostate" in clinical notes. PSA screening remains underused in primary care, even among high-risk patients. More risk factors were linked to higher testing rates, but African American and low-income groups were under-tested. Provider education and decision-support tools may improve guideline adherence and equity.

Keywords: PSA testing; prostate cancer screening; prostate-specific antigen.