Changes in Prostate Specific Antigen Screening Following the 2018 United States Preventive Services Task Force Guidelines and through the Covid-19 Pandemic

ABSTRACT

INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from "non-recommended" to "shared decision-making among men aged 55-69". Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHOD(S) We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULT(S) A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI 33.7%, 37.1%), 32.1% (95%CI 30.3%, 33.9%), 33.3% (95%CI 31.6%, 34.9%), 37.2% (95%CI 35.7%, 38.8%), and 34.9% (95%CI 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI 1.7, 7.5%) and increased 6.5% among men >70 (95% CI 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI 0.58%, 5.8%);PSA screening also decreased 0.8% among older men but did not reach significance (95% CI -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID =-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSION(S) We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population e men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic.