Divergent Trends in Prostate-specific Antigen Screening Prior to Testosterone Therapy in Younger vs Older Men Amidst Shifting Guidelines.

Overall PSA screening rates prior to testosterone replacement therapy were low across all men studied.

• Study included 74,463 men aged 40-69 who received TTh for hypogonadism between 2009 and 2022.
• Only 12.2% of men aged 40-54 were screened within 1 year before TTh initiation.
• Only 18.6% of men aged 55-69 were screened within 1 year before TTh initiation.
• Data were drawn from the TriNetX Research Network using a retrospective cohort design.
• Analyses were performed after 1:1 propensity score matching by age, race, ethnicity, and clinical characteristics.

PSA screening rates before TTh did not change across guideline eras for younger men aged 40-54.

• Screening rates for men aged 40-54 were 11.5% in the 2009-2012 era versus 12.2% in the 2013-2022 era.
• This difference was not statistically significant.
• The guideline eras compared were 2009-2012 versus 2013-2022.
• These findings suggest shifting guidelines did not impact screening behavior in this younger age group.

PSA screening rates before TTh increased significantly in the later guideline era for men aged 55-69.

• Screening rates for men aged 55-69 were 16.8% in the 2009-2012 era versus 19.5% in the 2013-2022 era.
• This increase was described as statistically significant.
• The divergent trend between age groups suggests guideline changes had differential impact by age.
• The authors suggest shifting guidelines may have contributed to this increase in older men.

Overall pre-TTh PSA screening rates did not differ by race, but Black men aged 40-54 had higher odds of screening than White men.

• No overall racial differences in PSA screening rates prior to TTh were detected across the full cohort.
• Black men in the 40-54 age group specifically had higher odds of pre-TTh PSA screening compared to White men.
• This finding is notable given that Black men are considered a higher-risk population for prostate cancer.
• Propensity score matching included race and ethnicity as matching variables.

The authors concluded that PSA screening before TTh remains inadequate, particularly in younger and high-risk men, underscoring the need for targeted educational strategies.

• Despite longstanding recommendations for PSA screening prior to TTh, rates remained low throughout the study period.
• Younger men (40-54) showed no improvement in screening rates across the study eras.
• The authors identified a need for 'education and targeted strategies to improve prostate cancer risk assessment before TTh.'
• Shifting guidelines were identified as a potential contributor to the observed divergent trends.