AUA 2022: PSA Screening on a Nationwide Level: Featuring the Contribution of Race and Life Expectancy in Decision Making

( The 2022 American Urological Association (AUA) Annual Meeting included a session on detection and screening of prostate cancer and a presentation by Dr. Nicholas Corsi discussing the impact of race and life expectancy in decision making for PSA screening at the nationwide level. Indeed, the mortality benefit of PSA screening is centered on patient’s life expectancy. While African American men represent a high-risk group for prostate cancer, there's limited evidence regarding the relationship between life expectancy and PSA screening in African American men. The aim of this study presented by Dr. Corsi and colleagues was twofold:

  1. To assess temporal trends in PSA screening in African American men, stratified by limited (i.e. <15 years) versus extended (i.e. ≥15 years) life expectancy using a nationally representative dataset
  2. To study the determinants and relative contribution of life expectancy on PSA screening utilization in AA men


 Utilizing the National Health Institution Survey (NHIS) from 2000-2018, Dr. Corsi identified African American men (using self-reported ethnicity) aged ≥40 years without a history of prostate cancer, who underwent PSA testing in the last 12 months as ‘a part of routine exam.' To assess life expectancy, they used the previously validated Schonberg index (based on 11 risk factors), which was developed using the NHIS dataset linked with the National Death Index to track mortality. Life expectancy-stratified temporal trends in PSA screening were analyzed separately for African American men. Weighted multivariable analyses and dominance analyses were performed to elucidate the predictors of PSA screening and their relative contribution.

 Within the NHIS-study years, 33,715 (weighted n=35,897,435; 57.3%) men were estimated to have extended life expectancy, while 29,212 (weighted n=26,7630,619; 42.7%) were included in the limited life expectancy. PSA screening declined significantly in African American men with limited life expectancy between 2008-2018, while increasing for those with extended life expectancy. However, life expectancy itself was not an independent predictor of receipt of PSA screening in multivariable analysis (OR 1.04, p=0.60), and accounted for only ∼0.3% of variability in screening on dominance analyses. The two most important factors predicting PSA screening were:

  1. Prior receipt of colonoscopy within last 10 years (OR 3.56, p<0.001; 59.8% relative contribution on dominance analyses)
  2. Visit to healthcare provider in the year prior (OR 2.20, p<0.001; 24.9% relative contribution) 

These two items together accounted for >80% of variation in screening even after adjusting for life expectancy. Similar results were seen in sensitivity analyses using life expectancy <10 years as a cut-off for limited life expectancy.


Dr. Corsi concluded his presentation discussing the impact of race and life expectancy in decision making for PSA screening at the nationwide level:

  • Screening rates declined for African American men with limited life expectancy, and increased for those with extended life expectancy over the last decade
  • However, these trends were seemingly driven more by social determinants of health (i.e. prior participation in screening practices like colonoscopy and regular access to health care provider) than life expectancy considerations itself


Presented by: Nicholas James Corsi, Wayne State University School of Medicine, MI

Co-Authors: Deepansh Dalela, Austin Piontkowski, Ivan Rakic, Sami E. Majdalany, Shravan Morisetty, Detroit, MI; Taylor Malchow, Dayton, OH; Marcus Jamil, Detroit, MI; Akshay Sood, Houston, TX; Sohrab Arora, Craig Rogers, Detroit, MI; Mara Schonberg, Boston, MA; Firas Abdollah, Detroit, MI


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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