Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick.
Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Netw Open. 2024 Jun 3;7(6):e2414582. doi: 10.1001/jamanetworkopen.2024.14582.
Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups.
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.
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.
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.
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).
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.
前列腺特异性抗原（PSA）筛查用于前列腺癌存在争议，但可能对某些高危人群有益。
评估县级 PSA 筛查流行率与前列腺癌结局之间的关联，以及社会人口统计学和临床因素的差异。
设计、地点和参与者：这项基于美国 8 个州癌症登记处的队列研究纳入了年龄在 40 岁至 99 岁之间的西班牙裔、非西班牙裔黑人和非西班牙裔白人男性，他们在 2000 年 1 月 1 日至 2015 年 12 月 31 日期间被诊断为前列腺癌。参与者随访至死亡或 10 年后截止（以先到者为准）或 2018 年 12 月 31 日，以先到者为准。数据分析于 2023 年 9 月至 2024 年 1 月进行。
使用 2004 年、2006 年、2008 年、2010 年和 2012 年行为风险因素监测系统调查数据估计县级 PSA 筛查流行率，并根据人口特征进行加权。
使用多变量逻辑、Cox 比例风险回归和竞争风险模型，估计诊断时县级 PSA 筛查流行率与晚期（区域性或远处）、全因和前列腺癌特异性生存率之间的关联的调整优势比（AOR）和调整风险比（AHR）。
在 814987 名患有前列腺癌的男性中，平均（SD）年龄为 67.3（9.8）岁，7.8%为西班牙裔，12.2%为非西班牙裔黑人，80.0%为非西班牙裔白人；17.0%患有晚期疾病。在 5716703 人年的随访中，有 247570 人死亡。与诊断时县级 PSA 筛查最低五分位数相比，最高五分位数的男性发生晚期疾病的可能性较低（AOR，0.86；95%CI，0.85-0.88），全因死亡率较低（AHR，0.86；95%CI，0.85-0.87），前列腺癌特异性死亡率较低（AHR，0.83；95%CI，0.81-0.85）。在西班牙裔男性中，PSA 筛查流行率与晚期癌症之间的负相关关系最强，而在其他种族中则较弱（AOR，0.82；95%CI，0.78-0.87），在年龄较大的男性中（年龄≥70 岁：AOR，0.77；95%CI，0.75-0.79），以及在东北部的男性中（AOR，0.81；95%CI，0.79-0.84）。在西班牙裔男性中，与全因死亡率的负相关关系最强（AHR，0.82；95%CI，0.78-0.85），在年龄较小的男性中（AHR，0.81；95%CI，0.77-0.85），在晚期疾病患者中（AHR，0.80；95%CI，0.78-0.82），以及在西部地区的男性中（AHR，0.89；95%CI，0.87-0.90）。
这项基于人群的前列腺癌男性队列研究表明，县级 PSA 筛查流行率较高与晚期疾病、全因死亡率和前列腺癌特异性死亡率较低相关。相关性因年龄、种族和族裔以及美国人口普查区域而异。
