Abstract
Objective
To assess whether prostate-specific antigen (PSA) testing rates prior to testosterone replacement therapy (TTh) differed by age (40–54 vs 55–69), race, and guideline era (2009–2012 vs 2013–2022).
Methods
We performed a retrospective cohort study using the TriNetX Research Network, including men aged 40–69 who received TTh for hypogonadism between 2009–2022. The primary outcome was PSA screening within 1 year before TTh. Analyses were performed after 1:1 propensity score matching by age, race, ethnicity, and clinical characteristics.
Results
Among 74,463 men, 12.2% of those aged 40–54 and 18.6% of those aged 55–69 were screened within 1 year of TTh initiation. For men aged 40–54, rates did not differ across eras (11.5% vs 12.2%). In men aged 55–69, screening increased significantly in 2013–2022 (16.8% vs 19.5%). Overall pre-TTh screening rates did not differ by race; however, Black men aged 40–54 had higher odds of screening than White men.
Conclusions
Despite longstanding recommendations, PSA screening prior to TTh remains low, particularly in younger and high-risk men. Shifting guidelines may contribute. These findings underscore the need for education and targeted strategies to improve prostate cancer risk assessment before TTh.
Keywords: Prostate-specific antigen, Testosterone therapy, Guideline adherence, Prostate cancer screening
Introduction
The American Urological Association (AUA) and Society of Urologic Oncology (SUO) updated its Early Detection of Prostate Cancer guidelines in 2023 and advise that clinicians may begin prostate cancer screening and offer a baseline prostate specific antigen (PSA) test to men between ages 45 to 50 (1). These age-specific guidelines using PSA testing for general prostate cancer screening have evolved significantly over the past 15 years. Before 2009, the AUA recommended baseline PSA testing at age 50; this was lowered to age 40 in the 2009 guideline update but later changed to 55-69 in the 2013 guideline, prior to the most recent change in 2023 (1-3). These changes have conflicted with other leading organizations; the United States Preventive Services Task Force, for instance, notably rejected PSA testing for prostate cancer in their 2012 guidelines but later endorsed a shared decision-making protocol for men aged 55-69 (4-6).
Further complicating this is that the AUA guideline for the Evaluation and Management of Testosterone Deficiency had recommended, in their first guideline published in 2018, that men over the age of 40 should be screened for prostate cancer with PSA testing prior to the initiation of testosterone replacement therapy (TTh) (7). Prior to this, Endocrine Society guidelines had recommended PSA testing before TTh initiation since 2006, with their 2010 update specifically recommending this in men over aged 40 who had a baseline PSA>0.6 and a general guideline to assess prostate cancer risk if considering TTh (8,9).
Given the frequent changes in general prostate cancer screening guidelines using PSA, we had several objectives. One was to evaluate the rates of PSA screening prior to TTh during these changing guideline eras and rates of prostate cancer diagnosed in those who started TTh. Next, we wanted to determine whether men were more or less likely to undergo PSA testing before starting TTh, stratified by age (40-54 vs 55-69), when comparing testing patterns between two guideline eras: 2009-2012, when general screening began at age 40, and 2013-2022, when it shifted to 55. We theorized that testing would be lower in younger men (aged 40-54) during the latter period due to the general screening age recommendations being increased from age 40 to 55, despite continued recommendations for screening in men over 40 initiating TTh. Lastly, we aimed to evaluate screening in higher-risk populations, particularly Black men, who face elevated prostate cancer incidence and mortality (6,10,11). The 2013 AUA guidelines encouraged individualized screening for high risk men aged 40-54, and the 2023 update specifically recommends baseline testing between ages 40-45 in Black men (1,3). Therefore, we aimed to evaluate whether Black men were more likely to undergo PSA testing prior to initiating TTh when compared to White men, hypothesizing that Black men would be more likely to be screened prior to initiating TTh due to their higher risk of prostate cancer with recommended earlier general prostate cancer screening recommendations.
Materials and Methods
We conducted a retrospective cohort study using a de-identified, federated electronic health record database (TriNetX Research Network, Cambridge, MA; Date of access: April 22, 2025), which includes data from 106 healthcare organizations and over 63 million male patients. Our study utilized the U.S. Collaborative Network, which contains over 132 million patients from 72 healthcare organizations, and complies with HIPAA and ISO 27001:2022 standards; because no identifiable data were used, IRB approval was not required. Data available included demographics, comorbidities, diagnoses (ICD codes), procedures (CPT, SNOMED), medications (RxNorm), and laboratory results.
We included adult male patients aged 40 to 69 years who were diagnosed with hypogonadism (ICD-10: E29.1) between 2009 and 2022 and received TTh (Rx code: 10379). Patients were stratified by age group (40–54 years vs. 55–69 years) and by time period (2009–2012 vs. 2013–2022).
Patients with a prior diagnosis of prostate cancer (ICD-10: C61) or without at least 1 follow-up encounter after initiation of TTh were excluded from the study.
The primary outcome, PSA testing for prostate cancer (CPT: G0102, G0103; or ICD-10: Z12.5), was evaluated up to 1 year before initiation of TTh. Patients were also evaluated for the following comorbidities: hypertension (ICD-10: I10), diabetes mellitus (ICD-10: E08-E13), cerebrovascular disease (ICD-10: I60-I69), obesity (ICD-10: E66), nicotine dependence (ICD-10: F17; Z71.6, Z87.891), and alcohol related disorders (ICD-10: F10). The incidence of prostate cancer (ICD-10: C61) was also assessed within five years following initiation of TTh.
Continuous variables are reported as means ± standard deviations (SD) and analyzed using independent t-tests, and categorical variables are presented as counts or percentages, with associations tested using chi-squared tests, or Fisher's Exact test for smaller sample sizes. To evaluate differences in PSA screening rates in accordance with AUA guidelines, patients were stratified by age at index and year of index, with comparisons made between the periods 2009–2012 and 2013–2022. To account for baseline differences in cohorts, we performed 1:1 greedy nearest neighbor propensity score matching based on age at index, race, ethnicity, and additional clinical characteristics (R package: MatchIt; Ho et al 2011). Associations between PSA screening and prostate cancer diagnosis within five years were examined both before and after matching. Further subgroup analyses investigated these associations within specific racial groups, including Black, or African American, and White hypogonadal patients.
Results
Among 36521 men aged 40-54 who initiated TTh, 5726 (15.6%) did so between 2009-2012 and 30795 (84.3%) between 2013-2022 (Table 1). Of all initiators, 4471 (12.2%) of these men had a PSA test within 12 months of initiating TTh. As shown in Table 1, baseline characteristics differed between periods within this age group. Notably, the 2013-2022 group had a higher proportion of White men (78.8% vs 77.6%, p=0.039) and a lower proportion of Black men (8.3% vs 10.3%, p<0.001) compared to 2009-2012. The most common comorbidity was hypertension (38.1%) followed by obesity (23.5%) and diabetes (16.4%). After propensity matching, 11452 men were included with 1135 (11.8%) undergoing PSA testing within 12 months of TTh initiation; pre-treatment testing rates of PSA were similar in these men between 2009-2012 and 2013-2022 (11.5% vs 12.2%, p=0.21). 103 (0.9%) were diagnosed with prostate cancer within 5 years, with no significant differences between guideline eras 2009-2012 and 2013-2022 (0.9% vs 0.9%, p=0.62)
Table 1.
Baseline characteristics, PSA screening, and incidence of prostate cancer within 5 years in hypogonadal patients aged 40-54 who initiated testosterone therapy in 2009-2012 vs. 2013-2022, before and after propensity score matching.
| Aged 40-54 | Before Matching | After Matching | ||||||
|---|---|---|---|---|---|---|---|---|
| Overall N = 36,5211 |
2009- 2012 N = 5,7261 |
2013- 2022 N = 30,7951 |
p- value 2 |
Overall N = 11,452 1 |
2009- 2012 N = 5,7261 |
2013- 2022 N = 5,7261 |
p- value 2 |
|
| Age at index | 47.7 ± 4.2 | 47.8 ± 4.2 | 47.6 ± 4.2 | <0.001 | 47.8 ± 4.2 | 47.8 ± 4.2 | 47.8 ± 4.2 | 0.97 |
| Race | ||||||||
| Black | 3,131 (8.6) | 587 (10.3) | 2,544 (8.3) | <0.001 | 1,148 (10.0) | 587 (10.3) | 561 (9.8) | 0.42 |
| Other | 1,998 (5.5) | 207 (3.6) | 1,791 (5.8) | <0.001 | 416 (3.6) | 207 (3.6) | 209 (3.7) | 0.92 |
| Unknown race | 2,667 (7.3) | 487 (8.5) | 2,180 (7.1) | <0.001 | 976 (8.5) | 487 (8.5) | 489 (8.5) | 0.95 |
| White | 28,725 (78.7) | 4,445 (77.6) | 24,280 (78.8) | 0.039 | 8,912 (77.8) | 4,445 (77.6) | 4,467 (78.0) | 0.62 |
| Ethnicity | ||||||||
| Hispanic or Latino | 2,290 (6.3) | 285 (5.0) | 2,005 (6.5) | <0.001 | 566 (4.9) | 285 (5.0) | 281 (4.9) | 0.86 |
| Not Hispanic or Latino | 25,344 (69.4) | 4,395 (76.8) | 20,949 (68.0) | <0.001 | 8,801 (76.9) | 4,395 (76.8) | 4,406 (76.9) | 0.81 |
| Unknown | 8,887 (24.3) | 1,046 (18.3) | 7,841 (25.5) | <0.001 | 2,085 (18.2) | 1,046 (18.3) | 1,039 (18.1) | 0.87 |
| BMI Comorbidities | 32.8 ± 6.2 | 32.0 ± 6.3 | 32.9 ± 6.1 | <0.001 | 32.2 ± 6.1 | 32.0 ± 6.3 | 32.3 ± 5.9 | 0.1 |
| Hypertension | 13,909 (38.1) | 2,058 (35.9) | 11,851 (38.5) | <0.001 | 4,139 (36.1) | 2,058 (35.9) | 2,081 (36.3) | 0.65 |
| Diabetes | 5,999 (16.4) | 965 (16.9) | 5,034 (16.3) | 0.34 | 1,917 (16.7) | 965 (16.9) | 952 (16.6) | 0.74 |
| Obesity (ICD) | 8,567 (23.5) | 965 (16.9) | 7,602 (24.7) | <0.001 | 1,929 (16.8) | 965 (16.9) | 964 (16.8) | 0.98 |
| Cerebrovascular disease | 672 (1.8) | 91 (1.6) | 581 (1.9) | 0.12 | 176 (1.5) | 91 (1.6) | 85 (1.5) | 0.65 |
| Nicotine dependence | 5,198 (14.2) | 631 (11.0) | 4,567 (14.8) | <0.001 | 1,238 (10.8) | 631 (11.0) | 607 (10.6) | 0.47 |
| Alcohol related disorder | 1,405 (3.8) | 218 (3.8) | 1,187 (3.9) | 0.86 | 408 (3.6) | 218 (3.8) | 190 (3.3) | 0.16 |
| Outcomes | ||||||||
| PSA screening | 4,471 (12.2) | 656 (11.5) | 3,815 (12.4) | 0.048 | 1,355 (11.8) | 656 (11.5) | 699 (12.2) | 0.21 |
| Cancer within 5 years | 322 (0.9) | 49 (0.9) | 273 (0.9) | 0.82 | 103 (0.9) | 49 (0.9) | 54 (0.9) | 0.62 |
Mean ± SD; n (%)
Welch Two Sample t-test; Pearson’s Chi-squared test
37942 men aged 55-69 were included, with 5952 (15.7%) initiating TTh in 2009-2012 and 31990 (84.3%) in 2013-2022 (Table 2). 7073 (18.6%) of these men had a PSA test within 12 months of initiating TTh. As shown in Table 2, baseline characteristics differed between periods within this age group. The 2013-2022 group had a slightly lower proportion of White men (81.4% vs 81.6%, p=0.67) and Black men (8.3% vs 8.9%, p=0.12) compared to 2009-2012. The most common comorbidity was hypertension (53.2%) followed by diabetes (26.4%) and obesity (22.7%). After propensity matching, 11904 men were included with 2162 (18.2%) undergoing PSA testing within 12 months of TTh. From 2013-2022, a significantly greater number of men underwent PSA testing prior to initiating TTh (19.5%) when compared to men from 2009-2012 (16.8%), p<0.001. 376 (3.2%) were diagnosed with prostate cancer within 5 years, with no significant differences between guideline eras 2009-2012 and 2013-2022 (3.3% vs 3.1%, p=0.53)
Table 2.
Baseline characteristics, PSA screening, and incidence of prostate cancer within 5 years in hypogonadal patients aged 55-69 who initiated testosterone therapy in 2009-2012 vs. 2013-2022, before and after propensity score matching.
| Aged 55-69 | Before Matching | After Matching | ||||||
|---|---|---|---|---|---|---|---|---|
| Overall N = 37,9421 |
2009- 2012 N = 5,9521 |
2013- 2022 N = 31,9901 |
p- value 2 |
Overall N = 11,9041 |
2009- 2012 N = 5,9521 |
2013- 2022 N = 5,9521 |
p- value 2 |
|
| Age at index | 61.3 ± 4.2 | 61.3 ± 4.2 | 61.4 ± 4.2 | 0.11 | 61.3 ± 4.2 | 61.3 ± 4.2 | 61.3 ± 4.2 | 0.94 |
| Race | ||||||||
| Black | 3,188 (8.4) | 531 (8.9) | 2,657 (8.3) | 0.12 | 1,057 (8.9) | 531 (8.9) | 526 (8.8) | 0.87 |
| Other | 1,619 (4.3) | 161 (2.7) | 1,458 (4.6) | <0.001 | 323 (2.7) | 161 (2.7) | 162 (2.7) | 0.96 |
| Unknown race | 2,247 (5.9) | 403 (6.8) | 1,844 (5.8) | 0.003 | 796 (6.7) | 403 (6.8) | 393 (6.6) | 0.71 |
| White | 30,888 (81.4) | 4,857 (81.6) | 26,031 (81.4) | 0.67 | 9,728 (81.7) | 4,857 (81.6) | 4,871 (81.8) | 0.74 |
| Ethnicity | ||||||||
| Hispanic or Latino | 1,508 (4.0) | 192 (3.2) | 1,316 (4.1) | 0.001 | 376 (3.2) | 192 (3.2) | 184 (3.1) | 0.68 |
| Not Hispanic or Latino | 26,830 (70.7) | 4,553 (76.5) | 22,277 (69.6) | <0.001 | 9,121 (76.6) | 4,553 (76.5) | 4,568 (76.7) | 0.75 |
| Unknown | 9,604 (25.3) | 1,207 (20.3) | 8,397 (26.2) | <0.001 | 2,407 (20.2) | 1,207 (20.3) | 1,200 (20.2) | 0.87 |
| BMI Comorbidities | 31.8 ± 5.9 | 31.3 ± 5.9 | 31.8 ± 5.9 | <0.001 | 31.3 ± 5.8 | 31.3 ± 5.9 | 31.2 ± 5.7 | 0.3 |
| Hypertension | 20,189 (53.2) | 2,993 (50.3) | 17,196 (53.8) | <0.001 | 5,983 (50.3) | 2,993 (50.3) | 2,990 (50.2) | 0.96 |
| Diabetes | 10,000 (26.4) | 1,492 (25.1) | 8,508 (26.6) | 0.014 | 2,965 (24.9) | 1,492 (25.1) | 1,473 (24.7) | 0.69 |
| Obesity (ICD) | 8,600 (22.7) | 901 (15.1) | 7,699 (24.1) | <0.001 | 1,803 (15.1) | 901 (15.1) | 902 (15.2) | 0.98 |
| Cerebrovascular disease | 1,736 (4.6) | 208 (3.5) | 1,528 (4.8) | <0.001 | 409 (3.4) | 208 (3.5) | 201 (3.4) | 0.72 |
| Nicotine dependence | 5,438 (14.3) | 458 (7.7) | 4,980 (15.6) | <0.001 | 915 (7.7) | 458 (7.7) | 457 (7.7) | 0.97 |
| Alcohol related disorder | 1,457 (3.8) | 189 (3.2) | 1,268 (4.0) | 0.004 | 348 (2.9) | 189 (3.2) | 159 (2.7) | 0.1 |
| Outcomes | ||||||||
| PSA screening | 7,073 (18.6) | 1,001 (16.8) | 6,072 (19.0) | <0.001 | 2,162 (18.2) | 1,001 (16.8) | 1,161 (19.5) | <0.001 |
| Cancer within 5 years | 1,147 (3.0) | 194 (3.3) | 953 (3.0) | 0.25 | 376 (3.2) | 194 (3.3) | 182 (3.1) | 0.53 |
Mean ± SD; n (%)
Welch Two Sample t-test; Pearson’s Chi-squared test
As shown in Table 3, the study included 59,613 White men and 6,319 Black men aged 40–69, of whom 9,385 (15.7%) and 1,154 (18.3%), respectively, underwent PSA testing prior to initiating TTh between 2009 and 2022. After propensity score matching, there was no significant difference in PSA testing rates prior to initiating TTh between White and Black men overall (p = 0.2). However, when stratified by age, Black men aged 40–54 had significantly higher odds of receiving PSA screening prior to TTh initiation compared to White men (OR 1.22 [1.06–1.40], p = 0.006). No significant difference was observed among men aged 55–69 (OR 0.92 [0.82–1.04], p = 0.2).
Table 3.
Incidence of PSA screening as a function of race in hypogonadal patients aged 40-69 who initiated testosterone therapy between the years of 2009 – 2022, before and after propensity score matching.
| Before Matching | After Matching | |||||
|---|---|---|---|---|---|---|
| PSA screening (n, %) |
OR (95% CI) |
P- value |
PSA screening (n, %) |
OR (95% CI) |
P- value |
|
| Overall: 40-69 | ||||||
| White (59,613) | 9,385 (15.7%) | - | - | 1,093 (17.3%) | - | - |
| Black or African American (6319) | 1,154 (18.3%) | 1.20 (1.12, 1.28) | <0.001 | 1,154 (18.3%) | 1.07 (0.98, 1.17) | 0.2 |
| Aged 40-54: | ||||||
| White (28,725) | 3,550 (12.4%) | - | - | 421 (13.4%) | ||
| Black or African American (3,131) | 498 (15.9%) | 1.34 (1.21, 1.48) | <0.001 | 498 (15.9%) | 1.22 (1.06, 1.40) | 0.006 |
| Aged 55-69: | ||||||
| White (30,888) | 5835 (18.9%) | - | - | 701 (22.0%) | ||
| Black or African American (3,188) | 656 (20.6%) | 1.11 (102, 1.22) | 0.021 | 656 (20.6%) | 0.92 (0.82, 1.04) | 0.2 |
Discussion
Despite longstanding recommendations from both the AUA and Endocrine Society to assess prostate cancer risk via PSA testing prior to TTh initiation, real-world adherence remains strikingly low in our study. From 2009-2022, only 12.2% of men aged 40-54 and 18.6% of men aged 55-69 were tested for PSA within 1 year of initiation of TTh. This is in contrast to a prior study by Baillargeon et al. who reported PSA screening rates exceeding 60% among men initiating TTh between 2001-2010 (12). Several factors may account for this discrepancy. First, Baillargeon’s study population consisted of insured patients from a commercial claims database, which may reflect a more health-engaged, regularly screened cohort compared to the more broad and diverse population in TriNetX (12,13). Second, evolving guideline ambiguity and fragmentation among professional societies may have contributed to clinical uncertainty and lower screening rates. Notably, the USPSTF’s 2012 recommendation against PSA based screening may have created confusion even for PSA testing done prior to TTh initiation, rather than for general, population-based prostate cancer screening (14-17). Other reasons include possibly increased provider comfort with TTh prescriptions over time, with less emphasis on cancer risk assessment as new safety data has emerged (18,19). Importantly, although screening rates were low, there were also very low rates of prostate cancer detection in men who started TTh, consistent with the literature (7,20). Only 0.9% and 3.2% of men aged 40-54 and 55-69 were diagnosed with prostate cancer within 5 years, with no significant differences when stratified by guideline era (2009-2012 vs 2013-2022).
However, our results question whether clinicians are adequately assessing prostate cancer risk before initiating TTh or if barriers exist that prevent guideline-concordant screening. Younger men (40-54), in particular, were regularly screened at lower rates compared to older men (55-69) across both guideline eras (2009-2012: 11.5% vs 16.8%; 2013-2022: 12.4% vs 19%). This suggests a potential decoupling of hypogonadism management from prostate cancer risk assessment in routine care, despite the recommendations to screen at age 40 if initiating TTh.
Our study also highlights the influence of guideline context on PSA testing patterns. Among younger men (aged 40-54), PSA testing rates did not significantly differ between 2009-2012 (when general prostate cancer screening was recommended to start at age 40) and 2013-2022 (when it shifted to age 55). We had theorized that testing in younger men (40-54) during the 2013-2022 guideline era would be lower as the general prostate cancer screening guidelines had increased to age 55, but this was not the case in our results. This suggests that prostate cancer screening may not have been systematically integrated into TTh evaluations, even during periods (2009-2012) when guidelines aligned more clearly. These findings underscore a potential misalignment between disease-specific guidelines and broader clinical practice, especially for younger men who may be less routinely targeted for PSA screening despite an increased risk with TTh.
However, for older men (aged 55-69), there was a significantly greater percentage of men who were screened during the guideline era of 2013-2022 as compared to 2009-2012, potentially reflecting improved guideline concordance in this age group or greater comfort among providers with screening in men who already fell within general screening recommendations. Perhaps as general prostate cancer screening guidelines emphasized shared decision making for men aged 55-69, clinicians may have been more likely to incorporate PSA testing into routine evaluations in this older cohort, especially for those starting TTh. These findings underscore the need for renewed efforts to align practice with guidelines and to clarify the importance of PSA testing not only for general cancer screening, but as a critical safety step in the evaluation of men undergoing hormone therapy.
The low screening rate may also reflect a missed opportunity, particularly in younger and higher risk populations. Black men, a historically high-risk group for prostate cancer (6,10,11), were screened at low numbers prior to TTh initiation; only 18.6% of Black men were tested for PSA before TTh in men aged 40-69 from 2009-2022. Despite this, when stratifying by race and age, we found that younger Black men (aged 40-54) were significantly more likely to undergo PSA screening prior to TTh compared to matched White men (OR 1.22 [1.06-1.40], p=0.006). Although no significant differences were observed for men aged 55-69, these findings are meaningful. They suggest that efforts to raise awareness of prostate cancer risk in younger Black men – whether through clinician education, advocacy, or guideline emphasis – may be having an impact, even if screening rates remain low overall (21,22).
This study has several limitations. Although patient-level data was used, the inherent limitations of the TriNetX database remain. TriNetX is a federated electronic health record network that aggregates data from multiple healthcare organizations. Therefore, it is subject to coding variability, incomplete documentation, and potential delays in data entry across institutions. Additionally, the database does not capture patient reported outcomes or the rationale behind clinical decision making, limiting our ability to assess the context surrounding PSA screening or TTh initiation. For example, we were unable to determine whether PSA testing was ordered specifically as part of the pre-TTh workup versus routine health maintenance, nor could we determine if patients declined testing.
Likewise, certain assumptions were made developing the hypotheses for this study. Notably, the recommendation to perform PSA testing in men over age 40 prior to initiating testosterone therapy was first formally introduced in the AUA Evaluation and Management of Testosterone Deficiency guideline in 2018 (7). Prior to this, there was no explicit guidance within AUA prostate cancer screening guidelines regarding PSA testing in the context of TTh. The Endocrine Society, however, had recommended PSA screening prior to TTh as early as 2006, with its 2010 update advising that men over 40 with a baseline PSA>0.6 ng/mL undergo further prostate cancer risk assessment before starting therapy (8,9). Therefore, unless urologists were closely adhering to Endocrine Society guidelines prior to 2018, there was no consistent specialty-specific recommendation within urology advocating for PSA testing prior to TTh during the earlier guideline era. Additionally, because we only captured PSA tests performed within one year prior to testosterone initiation, it is possible some men underwent PSA testing outside the window. Some clinicians may consider PSA values older than one year appropriate for baseline assessment, which could lead to an underestimation in our measurement of pre-treatment PSA testing.
Future research should explore whether the low rate of PSA screening seen here and differential rates by guideline era and age reflects patient-level factors, provider knowledge gaps, or system-level barriers. It would also be valuable to investigate whether the re-introduction of more aggressive screening guidelines in 2023 has led to measurable changes in current practice. Finally, future analyses could include stratification by provider specialty and examine outcomes such as treatment delays or prostate cancer stage at diagnosis among those not screened prior to TTh.
Conclusion
Despite the longstanding guidelines recommending PSA screening prior to testosterone initiation, adherence remains low - particularly among younger men and high-risk groups. These findings highlight a disconnect between guideline intent and clinical implementation, underscoring the need for improved education and targeted strategies to close the gap in prostate cancer risk assessment before TTh.
Conflicts of Interest and Funding:
This project was supported by the Clinical and Translational Science Collaborative of Northern Ohio which is funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UM1TR004528. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Footnotes
Ethical Approval:
This study was conducted using de-identified data from the TriNetx Research Network and was determined to be exempt from review by the University Hospitals Institutional Review Board.
Declaration of Interest Statement
The authors affirm they have no conflicts of interest relevant to this work
AI disclosure statement: The authors did not use generative AI or AI-assisted technologies in the development of this manuscript
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