Decrease in Presentation of High-Risk PSA Levels May Be Associated with Medicaid Expansion

May 7, 2020
Matthew Fowler
Matthew Fowler

A recent study found that the proportion of men with high-risk prostate-specific antigen levels at diagnosis was decreased in association with Medicaid expansion states.

A decrease in the proportion of young men presenting with prostate-specific antigen (PSA) greater than 20 ng/mL at the time of prostate cancer diagnosis was found to be associated with Medicaid expansion states, according to a recent study published in Cancer.

The data indicates that Medicaid expansion in states improved access to prostate cancer screenings for the investigated population.

“We sought to measure the correlation between Medicaid expansion and access to prostate cancer screening by assessing the proportion of men presenting with a high-risk PSA level (≥20 ng/mL) at the time of prostate cancer diagnosis, which is associated with a greater risk of disease recurrence after prostate cancer treatment and worse survival after a prostate cancer diagnosis,” wrote the researchers.

From 2012-2016, there was a statistically significant increase (18.9% to 19.8%) in the proportion of men with PSA levels greater than 20 ng/mL in nonexpansion states, while expansion states saw a decrease (19.9% to 18.2%) in that proportion of men. More, men in expansion states experienced a decline in PSA greater than 20 ng/mL (Difference-in-difference [DID], −2.33%; 95% CI, −3.21% to −1.44%; P< .001) when compared with men in non-expansion states.

Further, the proportion of men with high-risk disease decreased in expansion states relative to non-expansion states (DID, −1.25%; 95% CI, −2.26% to 0.25%; P= .015), and a statistically significant decrease in PSA levels greater than 20 ng/mL was noted among black men (DID, −3.11%; 95% CI, −5.25% to 0.96%; P= .005).

This retrospective cohort study examined 122,324 men aged younger than 65 years old who were diagnosed with prostate cancer within the National Cancer Database. DID analyses compared PSA levels at diagnosis “before expansion (2012-2013) and after expansion (2015-2016) between men residing in states that did or did not expand Medicaid.”

“By using a multivariable DID approach comparing PSA values between men in expansion and non-expansion states, we observed that Medicaid expansion was associated with decreases in the proportion of men presenting with PSA ≥20 ng/mL, a surrogate for disease with a high-risk of recurrence after treatment,” wrote the researchers. “Similarly, we also noted a decrease in the proportion of men presenting with high-risk disease in expansion states relative to non-expansion states.”

The researchers suggest future research should examine the relationship between Medicaid expansion and access to prostate cancer treatment for men in vulnerable populations. Specifically, the researchers suggest examining men of African heritage to determine the impacts of Medicaid expansion on access to prostate cancer.

The study utilized the National Cancer Database, which is limited by what variables it can capturing, meaning the study could not examine any unmeasured relevant variables. Even more, follow-up time was relatively short after Medicaid expansion. Even though the data suggests Medicaid expansion improved access to optimal care, screening rates in expansion states were not examined.

“These results are encouraging given the multitude of studies demonstrating sociodemographic disparities in prostate cancer outcomes,” wrote the researchers. “Previous work from population-based data in the United States noted that men with any insurance were much less likely than men without any insurance to present with metastatic disease at the time of prostate cancer diagnosis.”

Reference:

Weiner AB, Vo AX, Desai AS, et al. Changes in Prostate-Specific Antigen at the Time of Prostate Cancer Diagnosis After Medicaid Expansion in Young Men. Cancer. DOI: 10.1002/cncr.32930.