VA care is linked to less PSA testing when benefit is low
Among men 80 or older, adjusted PSA testing was 187.9 per 1000 person-years in VA care against 267.9 in fee-for-service Medicare.
JAMA Internal Medicine
In a retrospective cohort of 1.41 million male veterans aged 65 years or older dually enrolled in the VA and fee-for-service Medicare, researchers examined prostate-specific antigen (PSA) screening and biopsy rates across care settings. Using national linked data from 2004 to 2023, the study tracked testing patterns based on where veterans predominantly received primary care. Overall PSA testing declined across settings between 2008 and 2017, with steeper decreases in the VA system. From 2018 to 2023, veterans aged 80 or older in VA primary care had lower adjusted PSA testing rates (187.9 vs 267.9 per 1000 person-years; IRR, 0.70) and lower prostate biopsy rates (3.38 vs 5.05 per 1000 person-years; IRR, 0.67) than those in Medicare. Men with under five years of predicted life expectancy also had lower VA testing rates (IRR, 0.84), whereas testing was higher in the VA for men aged 65 to 69 (IRR, 1.10).
Why it matters
Aligning cancer screening with life expectancy may reduce low-value testing and procedural risks in older adults where potential harms can outweigh clinical benefits.
Caveats
The findings rely on a retrospective observational design using predicted life expectancy models. The results reflect male veterans dually enrolled in fee-for-service Medicare and may not generalize to other healthcare settings.
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
