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Too Little, Too Late? Characterizing PSA Screening History in Men with De Novo Metastatic Prostate Cancer
Angelo Blancaflor, BS1, Jack Mulcrone, BS1, Aaron Duong, BS2, Alejandro Rivera, BS2, Michael Chang, BS2, Grace Hyland, BS2, Luke Maietta, BS2, Natalia Alzate, BS2, Taylor Braunagel, MS2, Anthony Mega, MD3, Elias Hyams, MD2.
1The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Brown University Health, Minimally Invasive Urology Institute, Providence, RI, USA, 3Brown University Health, Division of Medical Oncology, Providence, RI, USA.
BACKGROUND: Rising metastatic prostate cancer (mPCa) incidence has been attributed to reduced PSA screening. It is commonly assumed that men presenting with de novo metastatic disease were inadequately screened. We characterized PSA screening history in men with de novo mPCa to test this hypothesis.
METHODS: We performed a single-center retrospective study (2017-2024) of men with de novo mPCa at the Brown Health Cancer Center. Patients were stratified by age (<55, 55-69, 70+), prior PSA screening, and guideline-concordant screening (annual/biennial PSA at ages 55-69). Metastatic extent was classified as oligometastatic (≤3 osseous/no visceral) vs. high volume metastatic. Multivariable logistic regression evaluated whether screening history predicted metastatic burden, adjusting for age, PSA (log₂), and symptoms.
RESULTS: Of 331 men (median age 71, IQR 64-78), 63.2% had high-volume metastatic disease. 194 (58.6%) had prior PSA screening, of which 73.2% were guideline-concordant. Among screening-eligible men aged 55-69 (n=142), 50.7% had been screened. In the 70+ group (n=178), 66.9% had prior screening. Among 120 screened men with penultimate PSA data, the median penultimate-to-diagnostic PSA interval was 91 days (IQR 64-206), with 72.5% having intervals <6 months. On multivariable analysis, neither screening status (OR 1.06, p=0.84) nor guideline concordance (OR 1.04, p=0.91) predicted metastatic extent; only symptomatic presentation (OR 2.28, p=0.003) and PSA (log₂ OR 1.54, p<0.001) were significant.
CONCLUSIONS: Most men with de novo mPCa had prior PSA screening, and the majority were guideline-concordant. Screening history was not associated with metastatic burden. While clinical trials have shown that screening reduces metastatic risk, these findings illustrate the limitations of screening in preventing metastatic disease for some men and highlight the heterogeneity of prostate cancer biology.
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