Introduction: Urologic prostate cancer screening guidelines universally recommend shared decision-making regarding prostate-specific antigen (PSA) testing. The objective of this study is to examine socio-demographic differences in shared decision-making for prostate cancer screening in the United States.
Methods: A retrospective cross-sectional study among men undergoing PSA screening was conducted using the 2018 National Health Interview Survey database in the United States. Outcomes included self-reported PSA testing and whether respondents had a discussion regarding its advantages with their healthcare provider. Multivariable logistic regression analyses were used to evaluate socio-demographic predictors of undergoing PSA screening and having a discussion regarding PSA testing advantages.
Results: 118,859 men were identified, of whom 1,550 (1.3%) had reported undergoing PSA testing, and 7,401 (6.2%) were asked whether PSA testing advantages were discussed. The mean age of the cohort was 63.7 years (SD 10.8). 6,029 (81.5%) were white, 765 (10.3%) were black, and 603 (8.1%) were other or multiple races. Only 37.3% (n=2,758) of men discussed advantages of PSA testing. On multivariable analysis, older (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) men were significantly more likely to undergo PSA testing (Table 1). However, on multivariable analysis, the same group of 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) men were significantly less likely to have a discussion regarding PSA testing advantages.
Conclusions: Disparities exist among shared decision-making in prostate cancer screening. Only about a third of men underwent discussion on PSA testing. Older men and minorities, including black and homosexual men, were less likely to have a discussion regarding advantages of PSA testing despite being more likely to undergo PSA testing.
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