UPJ INSIGHT Low-Value Prostate Cancer Screening Among Young Men With Private Insurance

By: Suzanne M. Lange, MD, Huntsman Cancer Institute, University of Utah, Salt Lake City, The University of Texas MD Anderson Cancer Center, Houston; Jeffrey Vehawn, MD, Huntsman Cancer Institute, University of Utah, Salt Lake City; Mouneeb M. Choudry, MD, Huntsman Cancer Institute, University of Utah, Salt Lake City, Mayo Clinic, Phoenix, Arizona; Jacob P. Ambrose, MS, Huntsman Cancer Institute, University of Utah, Salt Lake City, COTA, Inc, New York, New York; Caden M. Cluff, BS, Huntsman Cancer Institute, University of Utah, Salt Lake City; Benjamin A. Haaland, PhD, University of Utah, Salt Lake City; Niraj Paudel, MS, University of Utah, Salt Lake City; Jonathan Chipman, PhD, University of Utah, Salt Lake City; Heidi A. Hanson, PhD, Huntsman Cancer Institute, University of Utah, Salt Lake City, University of Utah, Salt Lake City; Brock B. O’Neil, MD, Huntsman Cancer Institute, University of Utah, Salt Lake City | Posted on: 19 Jan 2024

Lange SM, Vehawn J, Choudry MM, et al. Low-value prostate cancer screening among young men with private insurance. Urol Pract. 2024;11(1):110-115.

Study Need and Importance

This study examines PSA testing, which is known to contribute to low-value care when not used appropriately. Specifically, this study focused on PSA testing in young men under the age for 40, an age group where the recommendations are not clearly defined and the rates of testing are not well known.

What We Found

Using the MarketScan database, this study found that a remarkable proportion of men under 40 years of age are receiving PSA testing. Nearly 10% of men in their thirties had undergone PSA testing. A strong association between PSA testing and diagnoses of lower urinary tract symptoms and hypogonadism was identified (Table).

Table. Association Between Diagnoses and Charlson Comorbidity Index With Receipt of Prostate-Specific Antigen Testing, Stratified by Age Cohort

	18-39 y		55-69 y
	OR (95% CI)	P value	OR (95% CI)	P value
Infertility	1.08 (1.05, 1.12)	< .001	1.45 (1.4, 1.5)	< .001
Hypogonadism	11.77 (11.56, 11.99)	< .001	2.91 (2.86, 2.95)	< .001
LUTS	4.19 (4.13, 4.26)	< .001	4.05 (4.02, 4.08)	< .001
Depression/anxiety	1.29 (1.27, 1.3)	< .001	1.15 (1.14, 1.16)	< .001
CCI
0	1 (Ref)		1 (Ref)
1	1.39 (1.36, 1.42)	< .001	1.42 (1.41, 1.43)	< .001
2	1.37 (1.31, 1.44)	< .001	1.18 (1.16, 1.19)	< .001
3+	1.46 (1.38, 1.55)	< .001	0.88 (0.87, 0.89)	< .001
Abbreviations: CCI, Charlson Comorbidity Index; LUTS, lower urinary tract symptoms; OR, odds ratio; Ref, reference.

Limitations

Claims databases lack some detailed clinical information which contributes to decision-making in real practice. This study did not analyze specific provider types, which could have provided valuable insights into practice patterns, and it focused on a privately insured population, limiting its generalizability. It did not explore racial and ethnic factors, which are important in understanding associations with different demographics.

Interpretation for Patient Care

This study found that a substantial number of young men under 40 are undergoing PSA testing, a population in which prostate cancer is rare. An association of PSA testing with lower urinary tract symptoms and hypogonadism was identified. Evidence does not show a direct relationship of these diagnoses with prostate cancer, especially in young men under 40.

PSA testing is primarily an asymptomatic screening measure, and clinicians should avoid reflexively ordering it when other diagnoses arise. Screening in this age group may cause more harm than good. It is essential to provide clinicians and patients with proper education and clear guidelines on when to screen with PSA testing. We recommend against PSA screening in men under 40 and that guidelines clearly recommend this as well.