Divergent Trends in Prostate-specific Antigen Screening Prior to Testosterone Therapy in Younger vs Older Men Amidst Shifting Guidelines.

[OBJECTIVE] To assess whether prostate-specific antigen (PSA) testing rates prior to testosterone replacement therapy (TTh) differed by age (40-54 vs 55-69), race, and guideline era (2009-2012 vs 2013-2022).

[METHODS] We performed a retrospective cohort study using the TriNetX Research Network, including men aged 40-69 who received TTh for hypogonadism between 2009 and 2022. The primary outcome was PSA screening within 1 year before TTh. Analyses were performed after 1:1 propensity score matching by age, race, ethnicity, and clinical characteristics.

[RESULTS] Among 74,463 men, 12.2% of those aged 40-54 and 18.6% of those aged 55-69 were screened within 1 year of TTh initiation. For men aged 40-54, rates did not differ across eras (11.5% vs 12.2%). In men aged 55-69, screening increased significantly in 2013-2022 (16.8% vs 19.5%). Overall pre-TTh screening rates did not differ by race; however, Black men aged 40-54 had higher odds of screening than White men.

[CONCLUSION] Despite longstanding recommendations, PSA screening prior to TTh remains low, particularly in younger and high-risk men. Shifting guidelines may contribute. These findings underscore the need for education and targeted strategies to improve prostate cancer risk assessment before TTh.