AUA 2022: Racial and Ethnic Disparities Magnified After U.S. Preventative Services Task Force Category D Recommendation for PSA Screening

(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on the detection and screening of prostate cancer and a presentation by Dr. Caleb Bercu discussing the impact of the U.S. Preventative Services Task Force (USPSTF) Category D recommendation for PSA screening on racial and ethnic disparities. The incidence of metastatic prostate cancer has increased since 2008, and shifts in the USPSTF PSA screening recommendations may impact incidence of metastatic prostate cancer at presentation in racial and ethnic groups differently. This study by Dr. Bercu and colleagues sought to determine the temporal relationship of potential racial and ethnic disparities in presentation of metastatic prostate cancer prior to and after the USPSTF category D recommendation regarding PSA screening.


For this study, data were queried from the National Cancer Database from 2004 to 2017, a database sourced from 1,500 facility hospitals, representing more than 70% of newly diagnosed cancer cases. Logistic regression models were used to examine interactions of metastatic prostate cancer with age, race, ethnicity, geographic location, education level, income, and insurance status. In 2012, USPSTF published a category D recommendation against PSA screening. Linear regression models assuming underlying binomial distribution were fitted to annual rates of metastatic prostate cancer at presentation with an interaction for the years 2012-2017 to evaluate the post category D recommendation era.

The following figure depicts annual rates of presentation with metastatic prostate cancer, stratified by race:

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The difference in increasing slopes during the pre and post category D recommendation eras is statistically significant (p < 0.0001) for all groups including Hispanics, Non-Hispanic Blacks, and White men: 

PSA screening-1.jpg

As follows are the odds ratios for median household income category stratified by race/ethnicity: 

Notably, Hispanic and Non-Hispanic Black populations presented with highest rates of metastatic prostate cancer for both pre and post USPSTF category D recommendation eras. As part of his discussion, Dr. Bercu highlighted that the uninsured status of patients contributes to the risk of metastatic prostate cancer at presentation, with increased income representing a protective factor for advanced disease presentation. Furthermore, in the post grade D recommendation screening era, increased incidence of metastatic prostate cancer at presentation highlights disparities in non-Hispanic black and Hispanic populations.

Dr. Bercu concluded his presentation by discussing the impact of the USPSTF Category D Recommendation for PSA screening on racial and ethnic disparities with the following summary points:

  • Non-Hispanic Black and Hispanic individuals are more likely to present with metastatic prostate cancer compared to the White population
  • Since the USPSTF grade D recommendation against PSA screening, the incidence of presentation of metastatic prostate cancer has increased disproportionately in minority populations
Presented by: Caleb Bercu, Wake Forest University, Winston-Salem, NC

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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