Older men had lower prostate screening rates in VA primary care
Among men 80 or older, adjusted PSA testing rates were 187.9 per 1000 person-years in VA primary care versus 267.9 in fee-for-service Medicare.
JAMA Internal Medicine
A retrospective cohort study analyzed 1.41 million male US veterans aged 65 years or older dually enrolled in the VA and fee-for-service Medicare. Researchers examined linked records from fiscal years 2004 to 2023, covering 8.67 million person-years, to evaluate PSA testing and prostate biopsy rates across primary care settings.
Between 2018 and 2023, men aged 80 or older in VA primary care had lower adjusted PSA testing rates (IRR, 0.70) and prostate biopsy rates (3.38 vs 5.05 per 1000 person-years; IRR, 0.67) than those in fee-for-service Medicare. Testing was also lower in the VA for men with under 5 years of predicted life expectancy (IRR, 0.84). In contrast, VA testing was higher among men aged 65 to 69 years (IRR, 1.10).
Why it matters
Prostate screening offers minimal clinical benefit and carries risks of overtreatment for older adults with limited life expectancy. These findings indicate that health system structures can better align cancer screening practices with remaining life expectancy in aging populations.
Caveats
The study was observational and restricted to male veterans dually enrolled in the VA and fee-for-service Medicare, excluding those enrolled in Medicare Advantage.
The paper
Prostate Cancer Screening and Likelihood of Benefit in Veterans Affairs and Fee-for-Service Medicare
University of Michigan
JAMA Internal Medicine · 28 Sep 2026