PSA screening among young men in the United States

A new analysis finds that one in five men in their 40s has had a prostate specific antigen (PSA) test within the previous year and that young black men are more likely than young white men to have undergone the test.

The study, published in the September 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, provides valuable information as experts discuss possible changes to prostate cancer screening recommendations.

Currently, major medical organizations say evidence is insufficient to recommend routine prostate cancer screening using PSA or digital rectal exam (DRE). Rather, most group recommended men at average risk discuss with their doctor starting at age 50 whether to get tested. The American Cancer Society does though recommend that African Americans and men with a first degree relative with prostate cancer should , have screening every year, begin at age 45, and that men with two or more first degree relatives with prostate cancer begin testing at age 40.

To shed light on current PSA screening practices in young men, Dr. Judd Moul and Dr. Charles Scales, of Duke Prostate Center and Urologic Surgery at Duke University and colleagues obtained data from the 2002 Behavioral Risk Factor Surveillance System, an annual, population-based survey of civilian, non-institutionalized adults in the United States. The final sample for this study consisted of 58,511 men ages 40 and above.

The investigators found that one in five of them men had undergone screening in the previous year. Several sociodemographic characteristics were associated with PSA screening in younger men. In particular, young, black, non-Hispanic men were more likely than young white, non-Hispanic men to report having a PSA test in the previous year. This finding was independent of income, education and access to care. The authors noted that these results are reassuring, showing that physicians are more likely to recommend screening among black men due to this group's elevated risk for prostate cancer. However, they also noted that PSA screening in this group remains potentially suboptimal; only about one in three African American men reported having a PSA test in the previous year.

The survey also revealed that younger Hispanic men were more likely to undergo PSA testing than younger white, non-Hispanic men. The probability of undergoing a PSA test was also higher with increasing obesity, as well as with higher household income and education level. Health insurance coverage and an ongoing relationship with a physician were also strongly associated with having had a recent PSA test.

"Our study is the first to specifically examine PSA screening in younger men, which provides an important assessment of quality of care, especially for high-risk groups," the authors write. "Further investigation will be required to understand the impact of new risk-stratification strategies, with particular focus on the policy implications of potentially large increases in health care resource use".