PROSTATE SPECIFIC ANTIGEN SCREENING AMONGST SMOKERS: A U.S. NATIONAL BEHAVIORAL ANALYSIS

• Published in: Urologic oncology 2024-03, Vol.42, p.S76-S76
• Main Authors: Harmatz, I. Mitchell, Alkatib, Khalid Y., Leff, Morgan A., Cortese, Brian D., Mclauchlan, Nathaniel, Roberson, Daniel S., Michel, Katharine F., Schurhamer, Benjamin, Lee, Daniel J., Malkowicz, S. Bruce, Bivalacqua, Trinity J., Guzzo, Thomas J., Pierorazio, Phillip M.
• Format: Article
• Language: English
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2024.01.216

Prostate cancer (PCa) is the most prevalent non-skin cancer and the second leading cause of death from cancer in men in the United States. Evidence suggests that smoking is associated with higher-grade PCa at diagnosis with increased overall and PCa-specific mortality. Prostate specific antigen (PSA) screening significantly decreases the risk of PCa death. Previous studies indicate smokers are less likely to adhere to guideline-concordant cancer screening. Herein, we investigate the association between smoking;and PSA screening at a national level using the U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey. We hypothesize that smokers are less likely to undergo guideline-concordant PSA screening in comparison to non-smokers. Using the 2018 BRFSS survey cycle, we analyzed men aged between 55 and 69 who responded to the cigarette smoking and PSA screening questions. Smoking status was divided into never smoker, former smoker, and current smoker. Current smoker was further divided into daily and non-daily smokers. National PSA screening prevalence was calculated for each group. A complex weighted multivariable Poisson regression modeling adjusted for age, race, marriage status, education, income, health insurance, and having a personal doctor was then used to calculate the adjusted relative risk of undergoing PSA screening. 58,996 individuals representing a national estimate of 27.04 million responded to the smoking and PSA screening questionnaires. The overall national prevalence of PSA screening was 39% [95%CI; 39%-40%]. When categorizing by smoking status, the prevalence of PSA screening for never smokers; 42% [95%CI; 41%-44%], current smokers; 27% [95%CI; 25%-29%], and former smokers 42% [95%CI; 39%-40%] (see Table 1). Among current smokers, the prevalence was 27% [95% CI; 24%-29%] for those who smoke daily and 29% [95% CI; 24%-33%] for those who do not smoke daily. The adjusted relative risk (aRR) for undergoing PSA in comparison to those who never smoked was 0.81 for current smokers (95% CI: 0.75-0.88, P < 0.01) and 0.99 for former smokers (95% CI: 0.94-1.03, P = 0.53) (Table 2). Smokers are less likely to undergo PSA screening. Delay in diagnosis is one mechanism that could explain why smokers are more likely to present with high-grade prostate cancer at diagnosis.; Interventions to increase screening in this population may improve prostate cancer outcomes.; Further quantitative and qualitative studies are needed to further understan