Abstract
OBJECTIVES: To evaluate the impact of prostate-specific antigen (PSA) screening on prostate cancer (PCa) characteristics and survival outcomes in a contemporary cohort, amidst evolving PSA screening practices. METHODS: We retrospectively analyzed clinicopathologic data of 5,437 men diagnosed with PCa via prostate biopsy at our institution between 2006 and 2018. Patients were categorized as PSA-detected (PCa detected by PSA testing in asymptomatic individuals) or Symptom-detected (PCa detected after PSA testing prompted by symptoms). Temporal trends in PSA screening and cancer characteristics were assessed using correlation and time-series analyses. Multivariable Cox regression evaluated the effect of PSA screening on overall and cancer-specific survival. RESULTS: The PSA screening rate in our cohort increased from 46.4% in 2006 to 63.1% in 2018 (p < 0.001). Greater PSA screening uptake was associated with an increasing proportion of Gleason score 7 tumors (r = 0.608, p = 0.028), more localized-stage disease (r = 0.757, p = 0.003), and fewer cases of distant metastasis at diagnosis (r = -0.605, p = 0.028). The detection of clinically insignificant (low-risk) cancer rose modestly over time (r = 0.437, p = 0.136) but was not significantly influenced by PSA screening rates (r = 0.496, p = 0.085). On multivariate analysis, PSA screening was an independent predictor of improved overall survival (hazard ratio [HR] 0.54, p < 0.001) and cancer-specific survival (HR 0.46, p < 0.001). CONCLUSIONS: Increasing utilization of PSA screening correlated with a stage migration toward localized disease and a reduction in metastatic presentations, without a substantial increase in the detection of clinically insignificant cancer, as defined by Epstein criteria. PSA screening was an independent prognostic factor for better survival outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-025-14840-3.