Trends in PSA testing to screen for prostate-related conditions, including cancer

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Authors: Truveta Research Truveta, Inc, Bellevue, WA
Date: June, 2024



Prostate-specific antigen (PSA) is a protein produced by the prostate gland within males. It is produced normally; however, prostate cancer, prostatitis, and benign prostatic hyperplasia can cause increased levels. There are mixed screening recommendations. However, there is evidence of disparities in both PSA results and prostate cancer, where Black men are diagnosed at higher rates and with more severe disease. The objective of this study was to describe the variation in first-time PSA values across demographic and SDOH factors when stratified by age.

PSA testing, prostate-specific antigen testing, EHR data, prostate cancer screening

Using a subset of Truveta Data, we included males over the age of 18 who had at least one PSA lab test. We compared the distribution of first-time measured PSA values by age group. We also compared the distribution of PSA values across race, ethnicity, and income groups, when stratifying by age group. Second, we compared the percentage of monthly tests that were considered elevated, compared to those that were not elevated.



We included 3,935,951 men over the age of 18. First-time PSA lab values increased with increasing age. We also observed mean first-time PSA values 2.0x, 3.1x, and 2.4x higher for Black patients compared to white or Asian patients in the 40-59, 60-79, and 80+ year old age groups, respectively. The first-time mean PSA value decreased with increased income across the three oldest age groups. Men in the lowest income group ($0-35,000) had 1.9x, 2.6x, and 1.7x higher first-time age-specific average PSA values than men in the highest income group ($80,001+) for the 40-59 and 60-79, and 80+ year old age groups.

For all age groups under age 80, the percentage of PSA tests with elevated PSA has slightly increased in 2021-2023 (post-pandemic) compared to 2018-2019 (pre-pandemic).



In this study, we described both the rate of PSA testing for men by age group and demographic and SDOH differences in first-time PSA values. Consistent with the literature, we found higher first-time values for men in older age groups and Black men. Interestingly for the three age groups over 40 years of age, we found higher first-time PSA values were associated with lower individual income. Although this may represent additional disparities, caution should be taken when interpreting these results independently as we did not adjust for any other factors.