Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic.

INTRODUCTION: Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak. METHODS: We identified BPO surgeries from the California State Inpatient and State Ambulatory Surgery Databases between 2018 and 2020. Our primary outcome was the proportion of procedures performed in ambulatory settings with a length of stay of zero days. Univariable and multivariable analyses were performed to analyze factors associated with ambulatory surgery around the COVID-19 outbreak. Spline regression with a knot at the pandemic outbreak was performed to compare time trends pre- and post-pandemic. RESULTS: Among 37,148 patients who underwent BPO procedures, 30,067 (80.9%) were ambulatory. Before COVID-19, 80.1% BPO procedures were performed ambulatory, which increased to 83.4% after COVID-19 outbreak (p < 0.001). In multivariable model, BPO procedures performed after COVID-19 outbreak were 1.26 times more likely to be ambulatory (OR 1.26, 95% CI 1.14-1.40, p < 0.0001). Spline curve analysis indicated significantly different trend of change pre- and post-pandemic (p = 0.006). CONCLUSIONS: We observed a rising trend of BPO surgeries performed in ambulatory setting post-pandemic. It remains to be seen if the observed ambulatory transition remains as we continue to recover from the pandemic.

Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials.

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

Real-World Safety of Prostate Cancer Focal Therapy: MAUDE Database Analysis.

Objective: The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. Methods: The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. Results: We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% (n = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. Conclusions: Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.

Trends and Safety of Same-Day Discharge for Robot-Assisted Laparoscopic Prostatectomy: a Comparison between the Pre-Pandemic and Pandemic Periods from the National Cancer Database.

OBJECTIVE: To assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions. MATERIALS AND METHODS: We examined data from the National Cancer Database on men receiving RALP in the "Pre-pandemic" (2018-2019) and "Pandemic" (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics. RESULTS: Out of 111,117 men, 8,997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (p<0.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (p<0.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; p<0.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; p=0.95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; p=0.76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, p=0.21). CONCLUSION: SDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.

Industry-sponsored research funding to urologists in the United States between 2014 and 2022.

PURPOSE: Urologists face challenges in obtaining public research funding, leading to increasing reliance on the industry for research support. This study aimed to examine the extent and trends in industry-sponsored research payments to urologists from 2014 to 2022 in the United States. MATERIALS AND METHODS: We identified all US urologists using the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) database and extracted their industry-sponsored research payments data from the CMS Open Payments Database. We performed descriptive analyses of the payments data. RESULTS: Among 13,902 US urologists, 1330 (9.6%) received at least one industry-sponsored research payment. Urologists received $605.1 million between 2014 and 2022. Of all research payments, 98.7% ($597.4 million) were associated research payments for research where urologists served as principal investigators. The top 10% of urologists in research payments received 79.3% ($480.0 million) of total research payments. Only 0.4% ($2.3 million) of research payments were for preclinical research, while registered clinical trials totaled $159.0 million (26.3% of all research payments). The annual value of research payments increased from $35.2 million in 2014 to $101.7 million in 2022. The average percentage change in total payments showed a significant annual increase of 13.9% (95% confidence interval [95% CI]: 11.6% to 16.3%, p<0.001) in value. There was no significant trend in the number of urologists receiving research payments. CONCLUSION: Industry-sponsored research payments to urologists are substantial and have increased in both payment amount and number over time.

Investigating the pattern of prostate specific antigen screening among E-cigarette smokers within the behavioral risk factor surveillance system.

INTRODUCTION AND OBJECTIVES: E-cigarettes use has recently increased, even among older individuals quitting smoking. Though past studies suggest tobacco smokers may avoid cancer screening, the relationship between e-cigarette uses and preventive health behaviors like prostate specific antigen screening is uncertain. We assessed the relationship between self-reported e-cigarette smoking and prostate specific antigen screening utilization among US adults with a history of e-cigarette use. MATERIALS AND METHODS: We included men aged 50-69 years, who provided responses regarding PSA screening receipt and smoking status, from Behavioral Risk Factor Surveillance System 2020 and 2022 surveys. Primary outcome was PSA screening receipt. Multivariable regression model was performed to investigate the association between smoking status (never-smokers, current or former e-cigarette smokers, current or former tobacco smokers) and PSA screening. RESULTS: We included a weighted population of 8.1 million men aged 50-69. 2.3 million (28.3%) received PSA screening. 3.9 million (48.2%) were never-smokers. 1.3 million (16.6%) were from e-cigarettes smokers group, and 2.9 million (35.2%) were from tobacco smokers group. E-cigarettes smokers were less likely to receive PSA screening within last 2 years (0.76 [0.66-0.88]) than never-smokers. No significant difference in PSA screening was detected between never-smokers and tobacco smokers (0.91 [0.82-1.02]). E-cigarette smokers were less likely to receive PSA screening within the selected time frame (0.84 [0.72-0.97]) than tobacco smokers. When examining potential mediation by primary care visits, e-cigarette smokers were less likely to have had a check-up visit in past 2 years than tobacco smokers (0.77 [0.65-0.92]). CONCLUSIONS: E-cigarette smokers were less likely to undergo PSA screening than never-smokers and tobacco smokers, possibly due to reduced use of primary care services.

Absence of Race/Ethnicity Reporting in Clinical Trials of True Minimally Invasive Surgical Therapies for the Treatment of Benign Prostatic Hyperplasia.

OBJECTIVE: To assess the extent of racial reporting and enrollment in randomized controlled trials (RCTs) of minimally invasive surgical therapies (MIST) for the office-based treatment of benign prostatic hyperplasia (BPH). METHODS: A systematic review was conducted for RCTs assessing 6 office-based MISTs: transurethral microwave thermotherapy (TUMT), prostatic artery embolization, prostatic urethral lift, temporary implantable nitinol device, water vapor thermal therapy, and Optilume. MEDLINE, Embase, and the Cochrane CENTRAL databases were searched up to November 3, 2023. Publications were excluded if they (1) did not address one of the aforementioned office-based MISTs for the treatment of BPH; (2) were not RCTs; (3) were an abstract or conference proceeding; or (4) were not published in English. In addition to study characteristics, data about racial reporting were collected. Two independent reviewers completed screening at title, abstract, and full-text levels, with conflicts resolved by consensus with a third reviewer. RESULTS: A total of 61 publications representing 37 unique RCTs (n = 4027 unique patients) were reviewed, with publication years spanning from 1993 to 2023. TUMT was the most frequently studied MIST. Most publications (79%) were based solely in Europe or North America. Over 50% of the publications were multicenter trials. None of the included publications reported on race/ethnicity of study participants. CONCLUSION: None of the 61 included publications of RCTs of office-based MISTs provided information on racial/ethnic composition of study participants. There is a staggering gap in the standardization of race/ethnicity reporting and enrollment within RCTs of MISTs. More granular data on race/ethnicity allow for better generalizability and equity.

AI-derived Tumor Volume from Multiparametric MRI and Outcomes in Localized Prostate Cancer.

Background An artificial intelligence (AI)-based method for measuring intraprostatic tumor volume based on data from MRI may provide prognostic information. Purpose To evaluate whether the total volume of intraprostatic tumor from AI-generated segmentations (VAI) provides independent prognostic information in patients with localized prostate cancer treated with radiation therapy (RT) or radical prostatectomy (RP). Materials and Methods For this retrospective, single-center study (January 2021 to August 2023), patients with cT1-3N0M0 prostate cancer who underwent MRI and were treated with RT or RP were identified. Patients who underwent RT were randomly divided into cross-validation and test RT groups. An AI segmentation algorithm was trained to delineate Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions in the cross-validation RT group before providing segmentations for the test RT and RP groups. Cox regression models were used to evaluate the association between VAI and time to metastasis and adjusted for clinical and radiologic factors for combined RT (ie, cross-validation RT and test RT) and RP groups. Areas under the receiver operating characteristic curve (AUCs) were calculated for VAI and National Comprehensive Cancer Network (NCCN) risk categorization for prediction of 5-year metastasis (RP group) and 7-year metastasis (combined RT group). Results Overall, 732 patients were included (combined RT group, 438 patients; RP group, 294 patients). Median ages were 68 years (IQR, 62-73 years) and 61 years (IQR, 56-66 years) for the combined RT group and the RP group, respectively. VAI was associated with metastasis in the combined RT group (median follow-up, 6.9 years; adjusted hazard ratio [AHR], 1.09 per milliliter increase; 95% CI: 1.04, 1.15; P = .001) and the RP group (median follow-up, 5.5 years; AHR, 1.22; 95% CI: 1.08, 1.39; P = .001). AUCs for 7-year metastasis for the combined RT group for VAI and NCCN risk category were 0.84 (95% CI: 0.74, 0.94) and 0.74 (95% CI: 0.80, 0.98), respectively (P = .02). Five-year AUCs for the RP group for VAI and NCCN risk category were 0.89 (95% CI: 0.80, 0.98) and 0.79 (95% CI: 0.64, 0.94), respectively (P = .25). Conclusion The volume of AI-segmented lesions was an independent, prognostic factor for localized prostate cancer. © RSNA, 2024 Supplemental material is available for this article.

SGLT2 Inhibitor and Urinary Tract Infection in Men at Risk for Voiding Dysfunction: A VigiBase Analysis.

INTRODUCTION: We investigated the risk of UTIs and complex UTIs associated with SGLT2 (sodium-glucose cotransporter-2) inhibitors in men, emphasizing older men at higher risk for voiding dysfunction. METHODS: Utilizing a pharmacovigilance case-noncase design, we analyzed VigiBase reports from 1967 to 2022 among male patients. VigiBase is a comprehensive global database for drug safety. Disproportionality analysis, which compares the frequency of reported adverse events for specific drugs against other drugs, was conducted using reporting odds ratio (ROR) and empirical Bayes estimator (EBE). Age was stratified at 65 years as a threshold for increased susceptibility to male voiding dysfunctions. Sensitivity analyses were performed to compare SGLT2 inhibitor with other diabetes medications and years 2013 to 2022. RESULTS: There were 484 UTIs (ROR 6.75 [95% CI: 6.17-7.39]; EBE 6.78) and 165 complex UTIs (ROR 8.09 [95% CI: 6.94-9.43]; EBE 8.60). In men under 65, there were 178 UTIs (ROR 6.82 [95% CI: 5.88-7.91]; EBE 6.99) and 65 complex UTIs (ROR 7.30 [95% CI: 5.71-9.32]; EBE 7.90). In men 65 and over, we found 153 UTIs (ROR 5.11 [95% CI: 4.35-5.99]; EBE 5.44) and 59 complex UTIs (ROR 8.79 [95% CI: 6.79-11.37]; EBE 9.60). Sensitivity analyses consistently showed significant signals. CONCLUSIONS: This study suggests an elevated risk for both UTIs and complex UTIs in men taking SGLT2 inhibitors, with a more pronounced risk for complex UTI in older men who may have benign prostatic hyperplasia-related voiding dysfunction. These findings highlight the need for a balanced approach in prescribing SGLT2 inhibitors, particularly in populations potentially more susceptible to UTIs.

Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer.

BACKGROUND: Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments. METHODS: The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient. RESULTS: Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; P < .001). CONCLUSIONS: Our analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.

Tailoring language for genitourinary function in patients with newly diagnosed prostate cancer to facilitate discussions in diverse populations and overcome health literacy barriers.

BACKGROUND: Poor comprehension of prostate cancer (PCa) medical terms can create barriers to PCa treatment discussions. The authors measured comprehension of PCa terms and its relationship to health literacy in a group of Black men who were newly diagnosed with PCa. They examined whether tailoring communication with alternative colloquial words would be helpful and acceptable. METHODS: Patients were recruited from urology clinics (N = 152). After they met with their providers to discuss PCa treatment options, they participated in an educational supplement delivered as a structured interview. The supplement tailored PCa treatment information by allowing men to choose between colloquial and medical terms for genitourinary (GU) function. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine, and comprehension of common PCa terms was assessed using published methods. Pearson correlation was used to estimate the association between health literacy and comprehension of PCa terms. Spearman rank correlation (r) was used to assess the relation between the total number of medical terms preferred (range, 0-10) and Rapid Estimate of Adult Literacy in Medicine scores (range, 0-66). RESULTS: Most patients (62%) had low health literacy, which was strongly correlated with their understanding of PCa terms (r = 0.526; p < .001). Poor comprehension of many PCa terms established the need to use alternative language for GU function (only 20% knew the word incontinence). There was a statistically significant positive association between the number of medical terms preferred and health literacy (r = 0.358; p < .001). A majority of patients (91%) preferred a mixture of medical and colloquial terms. CONCLUSIONS: Tailoring communications with colloquial terms for GU function was preferred by most patients regardless of health literacy.

Identifying Barriers to Timely Follow-up After Elevated PSA Screening: A Retrospective Analysis of a Large Healthcare System.

OBJECTIVE: To examine elevated PSA follow-up within our system and identify areas for improvement in the timely diagnosis of prostate cancer. METHODS: We queried the Mass General Brigham's Enterprise Data Warehouse from 2018-2021, identifying patients with elevated PSA and documented time to follow-up. Timely follow-up was defined as having a urologist appointment, prostate biopsy, or prostate magnetic resonance imaging within 6 months from diagnosis. We stratified the location of elevated PSA diagnosis to academic medical centers versus community sites. Univariable and multivariable analyses were performed to identify factors impacting follow-up. RESULTS: We included 28,346 patients, with 50.30%, 15.02%, and 34.69% receiving timely, untimely, and no follow-up during the study period, respectively. In multivariable analysis, patients seen at academic medical centers were more likely to receive follow-up care (OR=1.39, 95%CI 1.30-1.48). In a sensitivity analysis including 2 of our largest community hospitals as part of academic medical facilities, those following up at our main sites showed even higher odds of timely follow-up (OR=1.61, 95%CI 1.51-1.73). CONCLUSION: Our study observed variations in follow-up rate between our academic medical centers and community sites. This finding highlights the need for efforts to improve consistency and timeliness of prostate cancer follow-up care across all facilities. By addressing interfacility disparities, we can facilitate the delivery of timely care to all patients.

Prostate magnetic resonance imaging utilization and its relationship with advanced prostate cancer detection.

BACKGROUND: The rise in advanced prostate cancer has coincided with increased use of Magnetic Resonance Imaging (MRI), leading to the hypothesis that this increase in surveillance registries is an artifact of more sensitive imaging tools. We assessed the association between regional variation in prostate MRI and advanced prostate cancer diagnoses. METHODS: We utilized SEER-Medicare data (2004-2015), including men > 65 diagnosed with localized prostate cancer. The predictor variable was the utilization of prostate MRI in each hospital referral region (HRR, representing regional healthcare markets). We compared the proportion of disease recorded as locally advanced or of regional risk group (cT3, cT4, and cN1) which would plausibly have been detected by prostate MRI. We conducted adjusted multivariable analysis and performed correlation analysis with Spearman rank coefficient at the level of the HRR. Sensitivity analysis for years 2011 to 2015 was conducted. RESULTS: Of 98,921 men diagnosed, 4.01% had locally advanced or regional disease. The median prostate MRI utilization rate was 4.58% (IQR [3.03%, 8.12%]). Adjusted multivariable analysis revealed no statistically significant correlation between MRI utilization and proportion of advanced prostate cancer (aOR = 1.01, 95% CI, [0.99,1.03]) in each region. The correlation between MRI usage and advanced diagnosis was not significant (Spearman Ρ = 0.09, P = 0.4). Sensitivity analysis conducted between 2011 and 2015 showed similar results (aOR = 1.008, 95% CI, [0.989, 1.027]; Spearman Ρ = 0.16, P = 0.1). CONCLUSIONS: During our study period, HRR-level utilization of MRI was not associated with higher incidences of advanced prostate cancer. This suggests the rising advanced prostate cancer diagnoses observed in this period are unlikely an artifact of greater sensitivity of modern imaging tests, but potentially due to other factors such as changes in screening or risk factors. With increased utilization and evolving techniques in recent years, the association between MRI and advanced prostate cancer detection warrants continued monitoring.

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

BACKGROUND: Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. METHODS: Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. RESULTS: Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. CONCLUSIONS: This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. PLAIN LANGUAGE SUMMARY: Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer.

Importance: Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives: To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants: This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. Exposure: County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Main Outcomes and Measures: Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer-specific survival. Results: Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer-specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). Conclusions and Relevance: This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer-specific mortality. Associations varied by age, race and ethnicity, and US Census region.