Introduction:

The USPSTF prostate cancer screening guidelines have changed significantly in the past decade, from a recommendation of do not screen in 2012 to a 2018 recommendation that focuses on shared decision making among men aged 55-69. In addition to making recommendations similar to the USPSTF, most guidelines further acknowledge that African American men should be screened more intensively than Caucasian men due to increased incidence of prostate cancer and increased prostate cancer mortality. Our objective was to characterize racial disparities in PSA screening and new prostate cancer diagnosis in a large healthcare system with a diverse patient population to understand contemporary trends.

Methods:

This retrospective cohort study used data from the Atrium Health Enterprise Data Warehouse, which includes clinical records from over 900 care locations across North Carolina, South Carolina, and Georgia. Participants included all men ≥ 40 years seen in the ambulatory or outpatient setting during 2014-2018. Men were excluded if they had a prostate biopsy within 24 months or prostate cancer diagnosis within 18 months prior to their index encounter. PSA testing was determined through laboratory data. Prostate cancer diagnoses were determined using International Classification of Diseases 9^th edition (ICD-9) and ICD-10 codes, with diagnoses confirmed by having relevant codes on at least two encounters after the index encounter. Clinical and demographic data were collected for all men, including age and race. Outcomes were reported for racial groups with > 2% representation in the population. Between-group comparisons were conducted using generalized estimating equations models to account for within-subject correlation. Statistical significance was defined as p < 0.05.

Results:

There were 582,846 men seen in the outpatient or ambulatory setting from 2014-2018, including 416,843 Caucasians (71.5%) and 85,773 African Americans (14.7%). Screening rates declined among all age and racial groups from 2014-2018 (see figure). African American men were screened at a significantly lower rate than Caucasian men in each year (from 19.1% vs 19.8% in 2014 to 12.3% vs 12.9% in 2018 respectively, p<0.05 for all years). The prostate cancer diagnosis rate declined across all age groups, with the largest declines in men aged ≥ 60. African American men had a significantly higher rate of prostate cancer diagnosis than Caucasian men in each year from 2014-2018.

Conclusion:

PSA screening and prostate cancer diagnoses declined significantly between 2014 and 2018. African American men were less likely to be screened for prostate cancer but more likely to be diagnosed with prostate cancer. Given the general consensus that African American men should be more intensively screened for prostate cancer, significant racial disparities remain in prostate cancer screening. Further study is warranted to understand patient, provider, and system factors that contribute to disparities in prostate cancer care and outcomes.

Funding: N/A