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- Title
Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer.
- Authors
Iyer, Hari S.; Stone, Benjamin V.; Roscoe, Charlotte; Hsieh, Mei-Chin; Stroup, Antoinette M.; Wiggins, Charles L.; Schumacher, Fredrick R.; Gomez, Scarlett L.; Rebbeck, Timothy R.; Trinh, Quoc-Dien
- Abstract
Key Points: Question: Is county-level prevalence of prostate-specific antigen (PSA) screening associated with lower mortality among men with prostate cancer? Findings: In this population-based multistate cohort study of 814 987 men with prostate cancer followed up for up to 10 years, higher prevalence of county-level PSA screening in the 2 years prior to diagnosis was associated with lower odds of advanced stage cancer, all-cause mortality, and prostate cancer–specific mortality. Inverse associations with overall mortality were strongest among men who were 70 years or older, were Hispanic, had regional or distant disease at diagnosis, and resided in the West US Census region. Meaning: This study suggests that men residing in counties with higher PSA screening prevalence prior to diagnosis had lower all-cause and prostate cancer-specific mortality; associations varied by sociodemographic and geographic factors, suggesting that targeted screening and linkage to treatment could improve prostate cancer survival. Importance: Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives: To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants: This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. Exposure: County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Main Outcomes and Measures: Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer–specific survival. Results: Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer–specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). Conclusions and Relevance: This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer–specific mortality. Associations varied by age, race and ethnicity, and US Census region. This cohort study evaluates associations of county-level prostate-specific antigen (PSA) screening prevalence with prostate cancer outcomes, including mortality, as well as variation by sociodemographic and clinical factors.
- Subjects
RISK assessment; PROSTATE-specific antigen; RESEARCH funding; EARLY detection of cancer; PROSTATE tumors; MULTIVARIATE analysis; DESCRIPTIVE statistics; HELP-seeking behavior; LONGITUDINAL method; BLACK people; ODDS ratio; RACE; SOCIODEMOGRAPHIC factors; CONFIDENCE intervals; PROPORTIONAL hazards models; DISEASE risk factors
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2414582
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.14582