The effect of physician-patient discussions on the likelihood of prostate-specific antigen testing

Many medical and professional organizations agree that men should discuss the advantages and disadvantages of testing for prostate-specific antigen (PSA) with their physicians before undergoing testing. In the 2000 National Health Interview Survey, men who had undergone a PSA test in the past were asked about their use of this test and discussions they had with physicians regarding its advantages and disadvantages. Among a group of 2,188 black and white men aged 40-79 years with no history of prostate cancer and a history of testing for PSA, we examined whether physician-patient discussions mediated the relationship between race and PSA testing. We specified that the test had to be their most recent one and part of a routine physical examination or screening test. We compared those tested within the past two years with those tested >2 years. Almost two-thirds of the men previously had discussions with their physicians about the advantages and disadvantages of the PSA test. Older men, college graduates, those living in the midwest and those with health insurance were more likely to have been tested recently. Discussion with a physician was found to mediate the relationship between race and PSA testing during the past two years. Black men were initially found to be more likely than white men to have been screened recently [odds ratio (OR)=1.45; 95% confidence interval (CI) 1.01-2.07], but in the full model race was no longer significant (OR=1.41; 95% Cl 0.98-2.03). Discussions about PSA testing were associated with more recent PSA screening (OR=1.38, 95% CI 1.05-1.82). These findings suggest that: 1) the relationships among race, physician discussions and PSA testing may need to be examined in more complex ways, and 2) the physician has an important role in men's decision to consider PSA testing.