Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System

Abstract

PSA testing is the primary method of screening for prostate cancer, although recommendations are varied. The COVID-19 pandemic diverted resources away from preventive screenings. We sought to examine alterations in PSA screening among TRICARE beneficiaries in the Military Health System (MHS) over the course of the pandemic. Using data from the MHS Data Repository, we executed a retrospective open cohort study of male TRICARE Prime beneficiaries aged 40 to 64 years during fiscal years 2018 to 2022. The study period was separated into 3 subperiods: prepandemic (October 1, 2017-February 28, 2020), early pandemic (March 1, 2020-September 30, 2020), and late pandemic (October 1, 2020-September 30, 2022). We found a 73% reduction in PSA screenings in the early pandemic and 14% decrease in the late pandemic compared with prepandemic rates. Compared with White men aged 50 to 54 years, men younger than 50 years in all racial groups were less likely to receive screening. In both pandemic periods, all racial groups, except for Black men, were overall more likely than White men to receive screening. Men were more likely to seek PSA screening in the private sector during the pandemic compared with prepandemic times (early pandemic: 1.21 RR, 1.20-1.22 95% confidence interval [CI]; late pandemic: 1.20 RR, 1.19-1.20 95% CI). We found significant reductions in PSA screening over the course of the COVID-19 pandemic among TRICARE beneficiaries. While disparities appear less pronounced when compared with other preventive testing, targeted outreach is still necessary for certain sociodemographic groups.