A trial of risk-adapted prostate cancer screening in a federally supported health center network serving a high-risk population

Sep 22, 2026

Uploaded by Levi

Background: Black men face earlier onset and higher prostate cancer mortality, yet interventions to promote adoption of risk-adapted PSA screening have not been tested. A 15-month trial evaluated “Smart PSA” guidelines in clinics serving Chicago communities with high prostate cancer burden. Methods: Providers received presentations, reminders, and on-site visits to apply race-, family history-, and baseline-PSA–linked recommendations. Outcomes assessed screening PSA changes and biopsy results. Results: Screening after encounters rose from 18.7 to 33.0 per 100; biopsy incidence and aggressive cancer prevalence increased.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

DOI: 10. 1002/cncr.70340 ORIGINAL ARTICLE A trial of risk-adapted prostate cancer screening in a federally supported health center network serving a high-risk population Peter H. Gann MD, ScD1,4 | Nathan Stackhouse MD, MPH2,3 | Nicole Gastala MD2,3 | Weiwei Ma PhD, MS4 | Margaret E. Wright PhD4 | Karriem Watson DHSc, MS, MPH, PhD3,4 | Christopher Stepping MEd5 | Patrice King-Lee MS1 | Ziqiao Xu MS4 | Tushar Patel MD 1 | Michael R. Abern MD6 1Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA 2Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois, USA 3Mile Square Health Center, UI Health, Chicago, Illinois, USA 4University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois, USA 5Business Intelligence, UI Health, University of Illinois at Chicago, Chicago, Illinois, USA 6Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA Correspondence Peter H. Gann, Department of Pathology, 840 South Wood Street, MC 847, Chicago, IL 60612-4325, USA. Email: [pgann@uic.edu](pgann@uic.edu) Abstract Background: Although Black men experience earlier onset and higher mortality from prostate cancer (PCa), no studies to date have tested interventions that encourage adoption of risk-adapted prostate-specific antigen (PSA) screening. The authors conducted a 15-month trial in clinics serving Chicago communities with high PCa mortality and Black population density. Their objective was to determine the impact of “Smart PSA” guidelines on screening behavior and biopsy outcomes. Methods: Through presentations, in-clinic reminders, and on-site visits, primary care providers (PCPs) were exposed to basic PSA guidelines recommending starting age, repeat test interval, and stopping age, based on race, family history, and baseline PSA. For the intervention period and a matched control period 3 years earlier, the authors extracted data from clinical databases on all visits by men age 35 and over, at six clinics. The primary end point was change in incidence of a screening PSA linked to a PCP encounter. Results: A total of 4252 and 4022 patients, similar in age and race, had qualifying encounters during intervention and pre-intervention, respectively. PSA screening following encounters increased from 18.7 to 33.0 per 100 patients (Δ = 14. 3; 95% CI, 12.4–16. 1) with odds ratio = 2.43 (95% CI, 2.17–2. 71), adjusted for pre-specified covariates. Guideline compliance was indicated by a larger increase in screening of younger Black patients, and earlier repeat testing after a borderline PSA. Increased screening of men 70 and older indicated potential noncompliance. Biopsy incidence increased from 0.57 to 0.92 per 100 (Δ = 0. 35; 95% CI,–0.03 to 0. 75), with PCa prevalence at biopsy increasing from 43% to 74%. Total PCa incidence rose 2.7-fold (0.25 to 0.68 per 100, p = .007), with incidence of cancer beyond grade group 1 increasing 3-fold (p = .008). This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2026 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society. Cancer. 2026;e70340. [https://doi.org/10.1002/cncr.70340](https://doi.org/10.1002/cncr.70340) wi[leyonlinelibrary.com/journal/cncr](leyonlinelibrary.com/journal/cncr) 1 of 10 Conclusion: These findings demonstrate that risk-adapted PSA guidelines can be adopted and sustained by PCPs in high-risk settings. Although PCa incidence increased substantially, the predominance of aggressive cancer was unchanged, consistent with the effect of intensified screening in a high-risk population with sparse prior screening for a cancer with long latency. Sustained intensification should eventually cause a

FAQs

What intervention did the trial test for prostate cancer screening?

The trial evaluated “Smart PSA” guidelines delivered to primary care providers through presentations, in-clinic reminders, and on-site visits.

How did screening behavior change during the intervention period?

After qualifying encounters, PSA screening increased from 18.7 to 33.0 per 100 patients, with results adjusted for pre-specified covariates.

What happened to biopsy outcomes and cancer incidence?

Biopsy incidence increased, biopsy PCa prevalence rose, and total prostate cancer incidence increased 2.7-fold, with higher incidence beyond grade group 1.

Sep 22, 2026

Uploaded by Levi