Changes in PSA-Based Early Detection of Prostate Cancer Over a 12-Year Period: Findings from the German KABOT Study

Background: The effectiveness of prostate-specific antigen (PSA) based early detection of prostate cancer remains controversial and implementation dependent. Screening policy changes have substantially altered PSA testing behavior in the United States, yet longitudinal evidence from non-organized European settings is limited. We assessed 12-year changes in awareness and utilization of PSA-based early detection and identified subgroups requiring targeted counseling. Methods: Two cross-sectional survey waves were conducted in 2009 (Study Phase 1) and 2021 (Study Phase 2) among men recruited via general practitioner practices in urban and rural regions of Germany. The survey was developed and reported according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Identical questionnaires were used across phases. Endpoints were awareness of PSA-based early detection and prior PSA testing. Univariable and multivariable logistic regression evaluated independent associations with sociodemographic and behavioral factors; subgroup analyses were performed in men aged 45–69 years. Results: The analytic cohort comprised 890 men (Study Phase 1, n=755; Study Phase 2, n=135). Compared with Study Phase 1, Study Phase 2 participants more frequently were non-smokers (63.0% vs. 48.5%, p< 0.001) and had a university degree (38.5% vs. 30.5%, p=0.002). In multivariable analyses, higher educational attainment (OR 1.71, 95% CI 1.24–2.36), smoking status (OR 0.69, 95% CI 0.48–0.99), and paternity (OR 1.94, 95% CI 1.25–3.01) were independently associated with greater awareness, whereas current smoking was independently associated with lower awareness of PSA-based early detection (OR 0.69, 95% CI 0.48-0.99). Utilization was independently associated with increasing age (OR 1.39, 95% CI 1.29–1.50) and higher educational attainment (OR 1.63, 95% CI 1.19–2.24), while current smoking was independently associated with a lower likelihood of having undergone PSA-based early detection (OR 0.61, 95% CI 0.41–0.91). Study phase was not independently associated with awareness or utilization. Conclusions: Over 12 years, awareness and utilization of PSA-based early detection remained stable in a German non-organized setting. Persistent social gradients underscore the need for targeted, evidence-based counseling, particularly for men with lower educational attainment and smokers.