Frequent PSA Screening for Prostate Cancer Likely Leads to Overdiagnosis

The U.S. Preventive Services Task Force (USPSTF) recommends shared decision-making about prostate-specific antigen (PSA) screening for prostate cancer in older men (age range, 55–69; NEJM JW Gen Med Jun 15 2018 and JAMA 2018; 319:1901); the American Urologic Association (AUA) agrees and recommends a screening interval of at least 2 years to minimize potential harms. Some men, however, seek PSA screening more frequently.

Using a claims database, researchers identified 3 million men (age, ≥30; 70% white) with either Medicare or private insurance who had ≥2 years of continuous insurance enrollment after their first PSA test between 2003 and 2019. “High-frequency PSA testing” was defined as ≥3 PSA testing intervals ≤270 days. Men who lost insurance or received diagnoses of or treatment for prostate cancer were dropped from the cohort.

The overall incidence of high-frequency PSA testing was 5%; incidence increased by about 0.5% annually, regardless of changes in guidelines. Men were more likely to have high-frequency testing if they were older, less educated, and nonwhite. Men with and without high-frequency testing had similar PSA levels; most men never had PSA levels >4 ng/dL, regardless of testing frequency. Men with high-frequency testing were significantly more likely than other men to have prostate biopsies and to receive diagnoses of prostate cancer; however, they were treated no more quickly, suggesting that much of the difference in incident cancer was due to overdiagnosis.