Primary Care Physician-led Population-based Screening Program for Prostate Cancer: Bridging a Urologic Gap in Access to Care.

OBJECTIVE

To evaluate the feasibility and outcomes of a primary care-led, community-based prostate-specific antigen (PSA) screening program designed to improve access to diagnosis in underserved populations.

METHODS

We retrospectively analyzed two cohorts: a Primary Analysis Cohort (n = 927; 6/2022-8/2023) to assess guideline adherence and clinical outcomes, and an Extended Programmatic Cohort (n = 1773; through 12/2024) to evaluate program scalability. Per 2023 AUA guidelines, screening was "appropriate" for men aged 45-69, or aged 40-44 with high-risk features (Black ancestry or family history). Patients with PSA >4ng/mL underwent repeat testing and/or mpMRI triage.

RESULTS

In the primary cohort, 833 (89.8%) participants were screened appropriately. Of the 94 (10.2%) screened outside guidelines, none were referred to urology. Among appropriately screened men with PSA >4 ng/mL (n = 71), 49 underwent mpMRI, with 23 (47%) demonstrating PI-RADS 3-5 findings. Twelve patients underwent biopsy, yielding nine (75%) prostate cancer diagnoses. Notably, 26 patients (48% of those with elevated PSA and completed work-ups) safely avoided urology referral through negative MRI findings or normalized repeat PSA results. In the extended cohort (n = 1773), the program resulted in 50 total urology referrals and 21 patients receiving definitive treatment.

CONCLUSION

This primary care-driven model effectively identifies clinically significant prostate cancer while maintaining high (90%) guideline adherence and reducing unnecessary specialist referrals. By integrating mpMRI triage, this framework provides a scalable strategy to bridge urologic care gaps and mitigate health disparities in underserved communities.