Zahava Berkowitz, Xingyou Zhang, Thomas B. Richards, Susan A. Sabatino, Lucy A. Peipins, Judith Lee Smith
Corresponding Author: Zahava Berkowitz, MSPH, MSc; Centers for Disease Control and Prevention (CDC). Email: zab3@cdc.gov
Section: Original Research
Publication: May 20, 2021
Background: In 2018, the U.S. Preventive Services Task Force (USPSTF) recommended prostate cancer screening for men aged 55─69 years who express a preference for being screened after being informed about and understanding prostate specific antigen (PSA) test benefits and risks. USPSTF recommended against screening men aged ≥70 years. We aim to generate county-level prevalence estimates, masked by national and state estimates, to identify counties with high PSA screening prevalence. Methods: We fitted multilevel logistic regression mixed models for 4 age groups (≥40, 40─54, 55─69, ≥70 years), using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n=116,654) and other sources. We evaluated consistency between our model-based state and BRFSS direct state estimates with Spearman and Pearson correlation coefficients. Results: PSA screening prevalence increased with increasing age groups: 7.7% for men aged 40-54 years, 27.2% for men aged 55-69 years, and 33.7% among men age ≥70 years, and was largely clustered in the South and Appalachia. Many county estimates among men aged ≥70 years exceeded 40%, especially in the South. Correlation coefficients were 0.94 for men aged ≥40, and ≥0.85 for men aged 40─54, 55─69, and ≥70. Conclusion: PSA screening was highest among men ≥70 years, for whom it is not recommended, and in the South among all age groups. Screening varied substantially within states. Impact: In 2018, on average, more than one in four men aged 55-69 years and one in three men aged ≥70 years underwent PSA screening in the prior year, suggesting potential overuse among some men.