Multicenter cohort study of PSA screening patterns and metastatic prostate cancer in US veterans

Metastatic prostate cancer (mPC) incidence has increased in US men, partly due to changes in PSA screening recommendations. A multicenter cohort study examined contemporary PSA testing practices associated with mPC incidence. The study included veterans within the Veterans Health Adminstration who received a prostate needle biopsy (PNB) between January 2015 and December 2023 with follow-up through 2024, excluding those with a history of PC. In this cohort study if 103,067 veterans, older age at screening start (≥60 versus <50 years) and higher baseline PSA value (>4 versus ≤ 1 ng/mL) were associated with 2.4-fold and 6.7-fold higher rate of mPC at diagnosis, respectively, with smaller associations with testing interval. Strategies combining younger ages and baseline PSA values were associated with lower rates of metastatic presentation, particularly in Black individuals. The authors conclude that these findings suggest that in high-risk populations such as male veterans, optimizing screening based on age at screening start and baseline PSA may reduce metastatic presentation.