PROSTATE CANCER SCREENING initiated before 50 and with lower baseline prostate specific antigen (PSA) levels was associated with significantly lower rates of metastatic prostate cancer at diagnosis among US veterans, according to a large cohort study involving more than 103,000 individuals.
Researchers analysed 103,067 veterans who underwent a first prostate needle biopsy between 2015-2023 and had no prior history of prostate cancer.
Among the study population, 3,773 participants (3.7%) were diagnosed with metastatic prostate cancer at the time of biopsy.
The investigators examined three screening factors: age at first prostate specific antigen test, baseline PSA level, and the longest interval between consecutive tests during the five years before biopsy.
Age at Screening Start Influenced Outcomes
The study found that later initiation of prostate cancer screening was associated with a higher risk of metastatic disease.
Compared with veterans who had their first prostate specific antigen test before age 50 years, those first tested between 50 and 59 years had an increased risk of metastatic prostate cancer.
Risk was even greater in those first screened at age 60 years or older.
Baseline PSA level showed the strongest association with metastatic presentation.
Individuals with an initial PSA level above 4 ng/mL had a much higher risk of metastatic prostate cancer than those with an initial PSA level of 1 ng/mL or less, with an adjusted hazard ratio of 6.67.
Prostate Cancer Screening Intervals Also Matter
Researchers found that veterans whose longest interval between screening tests exceeded 24 months experienced a higher risk of metastatic disease at diagnosis than those screened at intervals of 24 months or less.
The lowest risk was observed among veterans younger than 50 years at their first PSA test who also had screening intervals of 24 months or less.
Researchers observed that the highest risk group was individuals aged 60 years or older with screening intervals exceeding 24 months.
Implications for Risk Tailored Screening
The researchers also reported stronger associations between screening factors and metastatic disease among Black veterans, indicating that optimisation of screening strategies may be particularly relevant in higher risk populations.
Overall, these findings suggest that tailoring screening approaches according to age and PSA level at screening initiation may help reduce metastatic presentation in high-risk populations.
Reference
Siavoshi M et al. Prostate-Specific Antigen Screening Patterns and Metastatic Prostate Cancer in US Veterans. JAMA Netw Open. 2026;DOI:10.1001/jamanetworkopen.2026.21741
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