PSA Screening in VA Patients After Age 70 Years

TOPLINE: Most men receiving care through the Veterans Health Administration (VHA) continue prostate-specific antigen (PSA) screening after aged 70 years despite low absolute risk for prostate cancer-specific mortality (PCSM), even among Black men in the healthiest quintile.

METHODOLOGY: 
Researchers conducted a cohort study of 921,609 men aged 70 years receiving VHA care between 2008 and 2020, who had normal screening PSA values (< 4 ng/mL) between ages 65-69 years.

•      Analysis included electronic health record data from VHA Corporate Data Warehouse, linked Medicare claims data, and VHA community care data.
•      Investigators examined the value of PSA levels, race and ethnicity, and competing mortality in risk stratification for PCSM and mPCa using regression modeling.

TAKEAWAY:
The 10-year cumulative incidence of PCSM was 0.26% overall, with 95% of men having a 10-year risk < 0.73%, and higher baseline PSA levels associated with increased risk (0.79% for 3.00-3.99 ng/mL vs 0.10% for 0.20-0.99 ng/mL).

•      Race and ethnicity showed modest association with PCSM risk: Black patients had a 0.79% risk of mPCa vs 0.38% for White patients. The risk of PCSM was 0.36% for Black patients vs 0.25% for White patients.
•      Most patients (87%) continued PSA screening after age 70 years, with little variation by competing mortality risk or race and ethnicity.
•      Low PSA (0.20-0.99 ng/mL) identified very low-risk populations with < 1% 10-year risk for prostate biopsy, clinically significant prostate cancer diagnosis, and treatment.

IN PRACTICE: "Our data suggest that a simple assessment of personal risk based on PSA values before age 70 years captures a large proportion of relevant prognostic information with respect to mPCa and PCSM risk ... Low PSA (0.20-0.99 ng/mL) was associated with very low PCSM and mPCa risk, even among the healthiest Black men," wrote the authors of the study.

SOURCE: The study was led by Alex K. Bryant,MD, MAS and the Veterans Affairs Center for Clinical Management Research in Ann Arbor. It was published online on February 14 in JAMA Network Open.

LIMITATIONS: According to the authors, any potential PCSM or mPCa reduction from continued PSA screening > age 70 years remains unproven due to lack of randomized trial data. The study relied on death certificates to define PCSM, which may have introduced misclassification error. Family history of prostate cancer was not included due to unreliable electronic medical record data availability. Additionally, veterans have higher comorbidity burdens than the general population and unique military-related environmental exposures, potentially limiting result generalizability.

DISCLOSURES: The study was supported by grants U01CA253915, PSOCA097186, R35CA274442, and R50CA221836 from the National Cancer Institute. Matthew J. Schipper, MD, reported receiving consulting fees from Innovative Analytics. Phoebe A. Tsao, MD, disclosed receiving grants from the Prostate Cancer Foundation outside the submitted work. Kristian D. Stensland, MD, reported receiving a grant from the National Institutes of Health during the conduct of the study.

TOPLINE: Most men receiving care through the Veterans Health Administration (VHA) continue prostate-specific antigen (PSA) screening after aged 70 years despite low absolute risk for prostate cancer-specific mortality (PCSM), even among Black men in the healthiest quintile.

METHODOLOGY: 
Researchers conducted a cohort study of 921,609 men aged 70 years receiving VHA care between 2008 and 2020, who had normal screening PSA values (< 4 ng/mL) between ages 65-69 years.

•      Analysis included electronic health record data from VHA Corporate Data Warehouse, linked Medicare claims data, and VHA community care data.
•      Investigators examined the value of PSA levels, race and ethnicity, and competing mortality in risk stratification for PCSM and mPCa using regression modeling.

TAKEAWAY:
The 10-year cumulative incidence of PCSM was 0.26% overall, with 95% of men having a 10-year risk < 0.73%, and higher baseline PSA levels associated with increased risk (0.79% for 3.00-3.99 ng/mL vs 0.10% for 0.20-0.99 ng/mL).

•      Race and ethnicity showed modest association with PCSM risk: Black patients had a 0.79% risk of mPCa vs 0.38% for White patients. The risk of PCSM was 0.36% for Black patients vs 0.25% for White patients.
•      Most patients (87%) continued PSA screening after age 70 years, with little variation by competing mortality risk or race and ethnicity.
•      Low PSA (0.20-0.99 ng/mL) identified very low-risk populations with < 1% 10-year risk for prostate biopsy, clinically significant prostate cancer diagnosis, and treatment.

IN PRACTICE: "Our data suggest that a simple assessment of personal risk based on PSA values before age 70 years captures a large proportion of relevant prognostic information with respect to mPCa and PCSM risk ... Low PSA (0.20-0.99 ng/mL) was associated with very low PCSM and mPCa risk, even among the healthiest Black men," wrote the authors of the study.

SOURCE: The study was led by Alex K. Bryant,MD, MAS and the Veterans Affairs Center for Clinical Management Research in Ann Arbor. It was published online on February 14 in JAMA Network Open.

LIMITATIONS: According to the authors, any potential PCSM or mPCa reduction from continued PSA screening > age 70 years remains unproven due to lack of randomized trial data. The study relied on death certificates to define PCSM, which may have introduced misclassification error. Family history of prostate cancer was not included due to unreliable electronic medical record data availability. Additionally, veterans have higher comorbidity burdens than the general population and unique military-related environmental exposures, potentially limiting result generalizability.

DISCLOSURES: The study was supported by grants U01CA253915, PSOCA097186, R35CA274442, and R50CA221836 from the National Cancer Institute. Matthew J. Schipper, MD, reported receiving consulting fees from Innovative Analytics. Phoebe A. Tsao, MD, disclosed receiving grants from the Prostate Cancer Foundation outside the submitted work. Kristian D. Stensland, MD, reported receiving a grant from the National Institutes of Health during the conduct of the study.

TOPLINE: Most men receiving care through the Veterans Health Administration (VHA) continue prostate-specific antigen (PSA) screening after aged 70 years despite low absolute risk for prostate cancer-specific mortality (PCSM), even among Black men in the healthiest quintile.

METHODOLOGY: 
Researchers conducted a cohort study of 921,609 men aged 70 years receiving VHA care between 2008 and 2020, who had normal screening PSA values (< 4 ng/mL) between ages 65-69 years.

•      Analysis included electronic health record data from VHA Corporate Data Warehouse, linked Medicare claims data, and VHA community care data.
•      Investigators examined the value of PSA levels, race and ethnicity, and competing mortality in risk stratification for PCSM and mPCa using regression modeling.

TAKEAWAY:
The 10-year cumulative incidence of PCSM was 0.26% overall, with 95% of men having a 10-year risk < 0.73%, and higher baseline PSA levels associated with increased risk (0.79% for 3.00-3.99 ng/mL vs 0.10% for 0.20-0.99 ng/mL).

•      Race and ethnicity showed modest association with PCSM risk: Black patients had a 0.79% risk of mPCa vs 0.38% for White patients. The risk of PCSM was 0.36% for Black patients vs 0.25% for White patients.
•      Most patients (87%) continued PSA screening after age 70 years, with little variation by competing mortality risk or race and ethnicity.
•      Low PSA (0.20-0.99 ng/mL) identified very low-risk populations with < 1% 10-year risk for prostate biopsy, clinically significant prostate cancer diagnosis, and treatment.

IN PRACTICE: "Our data suggest that a simple assessment of personal risk based on PSA values before age 70 years captures a large proportion of relevant prognostic information with respect to mPCa and PCSM risk ... Low PSA (0.20-0.99 ng/mL) was associated with very low PCSM and mPCa risk, even among the healthiest Black men," wrote the authors of the study.

SOURCE: The study was led by Alex K. Bryant,MD, MAS and the Veterans Affairs Center for Clinical Management Research in Ann Arbor. It was published online on February 14 in JAMA Network Open.

LIMITATIONS: According to the authors, any potential PCSM or mPCa reduction from continued PSA screening > age 70 years remains unproven due to lack of randomized trial data. The study relied on death certificates to define PCSM, which may have introduced misclassification error. Family history of prostate cancer was not included due to unreliable electronic medical record data availability. Additionally, veterans have higher comorbidity burdens than the general population and unique military-related environmental exposures, potentially limiting result generalizability.

DISCLOSURES: The study was supported by grants U01CA253915, PSOCA097186, R35CA274442, and R50CA221836 from the National Cancer Institute. Matthew J. Schipper, MD, reported receiving consulting fees from Innovative Analytics. Phoebe A. Tsao, MD, disclosed receiving grants from the Prostate Cancer Foundation outside the submitted work. Kristian D. Stensland, MD, reported receiving a grant from the National Institutes of Health during the conduct of the study.