PSA screening and metastatic prostate cancer in the VA hospital system

In the U.S., fewer men have been undergoing PSA screening since 2008, (largely due to the U.S. Preventive Services Task Force (USPSTF) revision of national guidelines. In 2008, the USPSTF recommended against screening men older than 75 years of age. In 2012, the USPSTF issued a problematic grade “D” recommendation against PSA screening for all men, concluding that the harms outweighed the benefits. During this period, PSA screening rates and rates of interventions for prostate cancer diagnosis and treatment declined substantially. Fewer men were diagnosed and treated for the disease and the proportion of men diagnosed with metastatic cancer increased.

In 2018, USPSTF revised its recommendation again and now currently recommends that men 55-69 years of age discuss the benefits and harms of screening with their clinicians. The panel still advises against PSA-based screening for men aged 70 or older.

While there is no direct evidence linking the overall rate of PSA screening to the rate of metastatic prostate cancer the following synopsis of the VA Hospital System sheds light on this matter.

To understand if there’s a connection, researchers looked at data from 128 facilities within the Veterans Health Administration. They studied information from men aged 40 or older who had visited these facilities from 2005 to 2019. The study considered two things: the yearly PSA screening rates in each facility (the proportion of men aged 40 or older who got a PSA test each year) and the long-term non-screening rates (the proportion of men aged 40 or older who hadn’t had a PSA test in the past three years) from 2005 to 2014.

They looked at the number of new cases of metastatic prostate cancer diagnosed each year at each facility and calculated the rate of metastatic prostate cancer per 100,000 men, five years after each year of PSA screening.

The results showed that th overall rate of PSA screening in the VHA system went down from 47.2% in 2005 to 37.0% in 2019. During the same period, the rate of metastatic prostate cancer increased from 5.2 cases per 100,000 men to 7.9 cases per 100,000 men.

Interestingly, the study found that facilities with higher rates of PSA screening had lower rates of subsequent metastatic prostate cancer, suggesting a possible link between PSA screening and a lower risk of metastatic prostate cancer. On the other hand, facilities with higher long- term non-screening rates had higher rates of metastatic prostate cancer later on.

From 2005 to 2019, fewer men in the VHA system were undergoing PSA screening. The facilities with higher rates of PSA screening had fewer cases of metastatic prostate cancer in the following years. This information may be useful for men considering PSA screening and wanting to reduce their risk of metastatic prostate cancer.

JAMA Oncol. 2022;8(12):1747-1755. doi:10.1001/jamaoncol.2022.4319