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Background
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.
Sometimes a PSA test can find a cancer that, if not detected through screening, would never have caused any symptoms in the person’s lifetime because it was growing so slowly that the person died of something else before any symptoms occurred. This is called overdiagnosis. Although no one ever knows if they are overdiagnosed, the harm is detecting and treating a cancer that otherwise never would have caused the person any problems in their lifetime.
In 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening. In May 2018, the USPSTF published a final recommendation statement to update PSA screening guidelines for two subsets of the population:
- for men age 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer, and
- for men ages 55 to 69 years, the USPSTF recommends that clinicians inform them about the potential benefits and harms of PSA-based screening for prostate cancer, stating that the decision about whether to be screened for prostate cancer should be an individual one.
Measure
The percentage of men aged 55 to 69 years who reported having had a PSA test within the past year, by race/ethnicity, income, education level, and age. This provides information about the use of PSA testing in the population.
Measurement challenges
We track prostate cancer screening rates in U.S. using a large, national, in-person survey in which male respondents were asked several questions about prostate cancer and PSA testing, including whether they had ever had a PSA test and, if so, the time of their most recent test and the main reason for undergoing it (see Data Source, below). There are some limitations to this self-reported data that may impact what information we can accurately measure. Studies have shown that self-reported health care information is prone to biases because people may not know the specific purpose for receiving a test, or not remember the timing of the test.
In the case of PSA screening, it may be challenging to determine by self-report alone if a PSA test was received for screening purposes, i.e., to look for asymptomatic, previously undetected cancer, or for diagnostic purposes as a follow up on symptoms or suspicious findings from a prior test. In some cases, because PSA testing is a blood test it may be bundled by a doctor with many other tests, and a man may be unaware he even had the test. Even though the use of PSA testing measure may include tests for reasons other than screening or may miss tests, this data is the best national data on PSA screening and has been used to track PSA screening rates in the US.
Healthy People 2030 Target
There is no Healthy People 2030 target related to being screened for prostate cancer. There is a target goal to increase the proportion of men who have discussed the advantages and disadvantages of the PSA test to screen for prostate cancer with their health care provider.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Data Source
Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2005-2018.
In 2019 the NHIS questionnaire was redesigned to increase relevance, enhance data quality, and minimize respondent burden. In addition, the COVID-19 pandemic created challenges conducting in-person interviews for the 2020 NHIS, requiring changes to field procedures to conduct most surveys by telephone, which impacted survey response rates. For details related to the potential impacts of these issues, please refer to Potential Impact of NHIS Redesign and COVID-19 on the Cancer Trends Progress Report.
Trends and Most Recent Estimates
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
39.0 | 37.0 - 41.1 |
Non-Hispanic White
|
40.4 | 38.0 - 42.8 | |
Non-Hispanic Black
|
37.0 | 31.3 - 43.1 | |
Hispanic
|
33.2 | 25.9 - 41.3 | |
By Poverty Income Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
<200% of federal poverty level
|
27.1 | 23.4 - 31.3 |
>=200% of federal poverty level
|
42.2 | 39.9 - 44.6 | |
By Education Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Less than High School
|
27.8 | 21.7 - 34.8 |
High School
|
34.5 | 30.6 - 38.5 | |
Greater than High School
|
42.7 | 40.2 - 45.2 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Ages 40-54
|
13.4 | 11.9 - 15.0 |
Ages 55-69
|
39.0 | 37.0 - 41.1 | |
Ages 70+
|
44.6 | 41.8 - 47.5 | |
Additional Information on Prostate Cancer Screening
- Prostate Cancer Screening (PDQ®)-Patient Version. National Cancer Institute.
- Prostate-Specific Antigen (PSA) Test. National Cancer Institute.
- Q&A: What is Cancer Overdiagnosis? . National Cancer Institute.
- Prostate Cancer Screening Final Recommendations. U.S. Preventive Services Task Force.
- Prostate Cancer Screening Evidence-Based Programs Listing. National Cancer Institute.
- Prostate Cancer Screening (PDQ®)-Health Professional Version. National Cancer Institute.