In the absence of compelling level I evidence, high-quality epidemiological studies have sought to further evaluate population-level effects of PSA screening. In this study, we used validated methodology to develop a multilevel mixed effects model with poststratification using the Behavioral Risk Factor Surveillance System (BRFSS) and US Census data to estimate county-level PSA screening rates adjusted for age, race, ethnicity, and county-level poverty rates. This methodology, which provides accurate small-area estimates of health behaviors, enables assessment of the association of county-level screening rates with county-level prostate cancer outcomes from SEER and NCI/CDC State Cancer Profiles.6–8
We found that counties with 10% higher PSA screening rates from 2004-2012 were associated with 14% lower incidence of advanced prostate cancer from 2015-2019 and 10% lower prostate cancer-specific mortality from 2016-2020. Given the long natural history of prostate cancer, the long lag time in this study is an important advantage in understanding the impact of PSA screening. Despite the limitations inherent to this type of model, this study has substantial clinical implications adding to the growing body of literature in support of population-based PSA screening. Taken together, high-quality ecological and epidemiological studies suggest a real-world benefit of PSA screening in reducing rates of advanced prostate cancer and prostate cancer mortality.
Written by: Benjamin V. Stone, MD, Department of Urology, Brigham and Women's Hospital & Department of Urology, Massachusetts General Hospital
References:
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