PSA Screening Test Declines Have Not Recovered After COVID
Prostate cancer screening dropped from 2019, before the start of the COVID pandemic, to the second year in 2021, and numbers still hadn't rebounded by 2023.
This map of the United States shows that even the states with the highest prevalence of prostate cancer screening with a PSA test—North Carolina, South Dakota, and Wyoming—only had 37% of eligible men get screened. Puerto Rico had a higher percentage at 48%, which is still less than half.?
The Challenge
Screening for cancer saves lives. From 1975 to 2020 in the United States, 4.75 million deaths from breast, cervical, colorectal, lung, and prostate cancers were averted because of cancer prevention and screening efforts.
Early detection of prostate cancer with the PSA (prostate-specific antigen) test, along with improvements in disease management, has helped reduce prostate cancer death rates since 1993. However, since 2011, more cases of prostate cancer aren't being discovered until they have developed to a late stage.
Glossary for Nonscientists
Featured Term:
Screening prevalence
The proportion of people in a population who receive cancer screening during a defined time period. Screening prevalence is often expressed as a percentage.
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Plus, the disruption in screening during 2020 and 2021 due to the COVID-19 pandemic and the healthcare disruptions it caused, lowered the prostate cancer screening prevalence even more.?
Survival rates for late-stage prostate cancers are much lower than ones found at an early stage. Prostate cancer is usually curable when it’s found before it’s spread outside the prostate. With early-stage prostate cancer, 90% of men diagnosed at least 5 years ago live as long as men the same age who don’t have cancer.
For men who have late-stage prostate cancer, the survival rate is less than 50%. About 37% of men diagnosed at least 5 years ago live as long as men the same age who don’t have cancer. Accordingly, the prostate cancer death rate is increasing much more quickly than it had been.
This is why it’s essential that we track screening prevalence. The P站视频 (P站视频) and other guidelines recommend that screening decisions for prostate cancer happen in the context of shared decision making between?a man and a health care provider,?with men having the opportunity to make an informed decision about whether to be screened after discussing benefits, risks, and uncertainties most relevant to him.
Prostate Cancer Screening Guidelines
Screening for prostate cancer involves a PSA test: evaluating a small?sample of blood to check for PSA?levels. At the same appointment, some men may also have a rectal exam.
See "What to Know About the History of PSA Testing in the US" at the end of this article.??that a man should talk with his doctor about the?pros and cons of screening?for prostate cancer:
- Starting at age 40 if he has a very high risk of developing prostate cancer: He has more than 1 brother, or his father and a brother, developed prostate cancer before age 65.
- Starting at age 45 if he has a high risk of developing prostate cancer: He's Black or he's a part of any racial population and has a father or brother who were diagnosed with prostate cancer.
- Starting at age 50 if he's not Black and has an average risk of developing prostate cancer.
In 2019, the year before the pandemic started, only 24% of age-eligible men said they had talked with a doctor about their personal need for PSA testing, and 63% said they had never discussed it.
The Research
During the COVID-19 pandemic, many doctor’s offices and hospitals limited who could see a health care professional face to face, and some closed their offices completely. That meant that people seeking nonurgent or preventive care, including men wanting to be screened for prostate cancer, didn’t have access to it.?
P站视频 Screening Surveillance researchers track changes in how many people get screened for cancer and kept on top of how disruptions to standard preventive care was affected throughout the COVID-19 pandemic. The team published studies every year,?starting from the time when data became available in 2021.
Combining data from 2 of their published studies provides a good picture of how screening prevalence before the pandemic (2019) changed during it (2021) and after it (2023).
- In 2023, the team comparing screening prevalence during the second year of the pandemic (2021) to the prevalence before the pandemic (2019) for breast, cervical, colorectal, and prostate cancer in the?Journal of Clinical Oncology.
- In 2025, the team published a study in?Cancer Epidemiology, Biomarkers, & Prevention?, major modifiable cancer risk factors, and HPV vaccination after the COVID-19 pandemic (2023).
All studies included leadership from P站视频 surveillance researchers?Jessica Star, MA, MPH;?Priti Bandi, PhD;?Xuesong Han, PhD; and?Ahmedin Jemal, DVM, PhD.
Prostate Cancer Screening Prevalence
Here's an overview of P站视频 researchers' findings about prostate cancer screening.
2019, PreCOVID-19:?38% of all men in the US and Puerto Rico who were eligible for prostate cancer screening received it
2020, 1st?year of the pandemic:?Puerto Rico had the highest prevalence with 48% of men getting a PSA test. In the states, screening prevalence ranged between 22% and 37%. The states with the fewest men being screened for prostate cancer (22%) were New Mexico and Vermont. See the map at the top of the page for screening prevalence by state.
2021, 2nd?year of the pandemic:?34.3% prostate screening prevalence, a 10% decrease from 2019
2023, PostCOVID-19: ?36.6%, a rebound from 2021, but still lower than before the pandemic in 2019
Screening Differences
By income:?Prostate cancer screening prevalence declined in men with 100% to 199% of the federal poverty level (FPL) but not in those with income less than 100% of the FPL.
How Education Level Affects the Percentage of Men Who Get PSA Tests
How Race Affects the Percentage of Men Who Get PSA Tests?
How Health Insurance Coverage Affects the Percentage of Men Who Get PSA Tests?
Why It Matters
In the past 15 years, the prevalence for prostate cancer screening has gone up and down as the guidelines for PSA tests have fluctuated. (See “What to Know About the History of PSA Testing in the US” below.)
These P站视频 COVID-19 screening studies show that, despite a small rebound, prostate cancer screening prevalence is still lower than it was before the COVID-19 pandemic. And that raises the risk of more prostate cancers not being diagnosed until that are at a later stage, which makes them less likely to be cured.
Advanced prostate cancer is linked with multiple health issues and premature death. What’s more is that Black men have a disproportionately higher risk of developing an advanced stage of prostate cancer.
These findings and facts reinforce the importance of making strong return-to-screening campaigns after a disruption. Designs for effective campaigns must include screening recommendations from physicians and other health care providers because research has shown that reminders from providers greatly improve the success of screening campaigns.
Even with gains in screening prevalence after the COVID-19 pandemic, the prevalence for all types of cancer screenings continue to be low, especially for people with insurance barriers, lower socioeconomic status, and certain racially marginalized groups. To address these disparities, the P站视频 study authors suggest that the US federal and state governments and policy makers use system-level and educational interventions that have been shown to improve screening prevalence and reduce screening disparities:?
- Maintain the Affordable Care Act (ACA) provisions for screening coverage without any cost to the patient (no cost-sharing)
- Keep health care navigation programs to guide patients through the screening continuum
- Continue ongoing surveillance with reliable ways to represent a variety of populations and national-, state-, and local-level datasets to track progress and develop interventions.
What to Know About History of PSA Testing in the US
In 2008, the US Preventive Services Task Force (USPSTF) recommended against regular PSA screening?for men age 75 and older. The change was prompted by a national trend of overdiagnosis of prostate cancer—treating prostate tumors that wouldn’t have caused any harm with treatments that caused harmful, permanent side effects for most men.
In 2012, the Task Force recommended against routine PSA screening for all men.?
(See current P站视频 recommendations for prostate cancer early detection.)
In 2018, the USPSTF reversed that decision and recommended shared decision-making for PSA testing starting at a younger age than before—those 55 to 69.
Despite recommendations by USPSTF and P站视频, shared-decision making remains low in the US.