Prostate Cancer Screening Patterns in Primary Care
PROSTATE cancer screening remains inconsistent in U.S. primary care, even for men at clearly elevated risk.
In this retrospective analysis of 176,326 men aged 40 years and older seen in primary care clinics from 2020 to 2022, investigators examined prostate cancer screening practices using prostate-specific antigen testing. Each patient received a risk score based on the number of established prostate cancer risk factors, then univariate and multivariate models were used to test associations between risk scores, screening, and cancer diagnosis.
Overall, only 31.4% of men underwent PSA testing. Screening rates increased with rising risk burden and reached 78.1% among those with a risk score of 4. The predictive model showed a strong association between increasing risk scores and PSA testing, with highly significant results. Men with Medicaid or commercial insurance had higher odds of PSA testing than those with Medicare, whereas self-pay patients were less likely to be tested. Former and never smokers were more likely to undergo PSA screening than current smokers.
Age, African American race, and family history of prostate cancer all increased the likelihood of receiving PSA testing. However, the authors report that African American and low-income patients remained under-tested relative to their elevated risk, underscoring persistent inequities within primary care.
Risk Factors, Testing Odds, And Cancer Diagnosis
Prostate cancer diagnosis rates also rose with cumulative risk. Among men with a risk score of 5, one in four received a prostate cancer diagnosis. In multivariable models, older age, African American race, family history, and explicit mention of the word “prostate” in clinical notes significantly predicted prostate cancer diagnosis. These findings suggest that clinician attention to prostate health during encounters is closely tied to both testing behavior and case detection.
Implications For Prostate Cancer Screening Equity
The study indicates that prostate cancer screening in high-risk patients remains suboptimal, even when multiple risk factors are present. Despite higher PSA testing odds at higher risk scores, African American and low-income men still experience lower-than-expected screening rates. The authors highlight the need for targeted provider education and practical decision-support tools in primary care to align practice with risk-based guidelines, reduce missed opportunities for early detection, and improve equity in prostate cancer outcomes.
Reference: Ghosh AK et al. Prostate Cancer Screening Practices Among High-Risk Patients: A Retrospective Analysis. Am J Mens Health. 2025;19(6):15579883251392440.
