Disparities Exist on Discussions for PSA Testing for Prostate Cancer

Racial/ethnic and sexual minorities, as well as older men with or at risk for prostate cancer, experience disparities in shared decision-making, particularly when it comes to discussions on the advantages of prostate-specific antigen (PSA) testing, according to a study presented at the 2022 American Urological Association Annual Meeting.

Michael Basin, MD, of the Suny Upstate University Hospital in Syracuse, New York, who presented the research findings, noted that current urologic prostate cancer screening guidelines recommend a shared decision-making approach to PSA testing in prostate cancer screening. Despite these recommendations, however, few studies have characterized the socio-demographic differences in shared decision-making in US-based prostate cancer screening programs.

Dr. Basin and colleagues sought to meet this research gap by conducting a retrospective cross-sectional study that included men who underwent PSA screening in the United States. The analysis focused on patients who were included in the 2018 National Health Interview Survey database in the United States.

The outcomes of the analysis were self-reported PSA testing and whether discussions were had between patients and providers regarding the advantages of PSA testing. The investigators conducted multivariable logistic regression analyses to examine the socio-demographic predictors of PSA screening uptake and shared discussions between providers and respondents regarding the advantages of PSA testing.

Approximately 1.3% (n=1550) of the 118,859 men in the survey (mean age = 63.7 years) reported undergoing PSA testing. Around 6.2 % (n=7401) of respondents were asked whether the advantages of PSA testing were discussed by their healthcare providers.

Most respondents to the survey were White (81.5%), while 10.3% (n=765) were Black, and 8.1% (n=603) were “other” or multiple races.

The advantages of PSA testing were reportedly discussed with only 37.3% (n=2758) of the male patients. According to the multivariable analysis, those who were significantly more likely to undergo PSA testing were those who were older (odds ratio [OR] = 1.079; 95% CI 1.073-1.086, p<0.001), Black (OR=1.324; 95% CI 1.117-1.570, p=0.001), and homosexual (OR=1.701; 95% CI 1.223-2.236, p=0.002).

Despite these findings, the multivariable analysis also found that those who were significantly less likely to have a discussion regarding the advantages of PSA testing included the same group of patients who were older (OR=0.962; 95% CI 0.956-0.967, p<0.001), Black (OR=0.614; 95% CI 0.524-0.720, p<0.001), and homosexual (OR=0.532; 95% CI 0.390-0.726, p<0.001).