Factors influencing men's decisions regarding prostate cancer screening: a qualitative study

Shared decision making is recommended before prostate cancer screening. Little is known regarding reasons why men choose to get or not get prostate cancer screening, particularly in white or Hispanic men. We conducted semi-structured in-depth interviews of 64 men, age 50 years and over, purposively sampled from men who were never screened for prostate cancer or who screened abnormal in northern New Jersey. Qualitative analysis was iterative using a grounded theory approach involving a series of immersion/crystallization cycles. Men who had abnormal PSA tests either actively sought out screening because of family history of prostate cancer or received their screening as part of a routine physical examination. Men who were never screened avoided testing primarily because they perceived they were at low risk due to lack of urinary symptoms, lack of family history of prostate cancer, or beliefs that healthy behaviors can prevent prostate cancer. Other reasons for not getting screened included: fear of cancer, embarrassment over digital rectal exam, confusion over the screening procedure, and skepticism over the benefits of screening. Some men were willing to get screened if structural barriers were removed, their doctor recommended it, or if they were prompted by urinary symptoms. None had discussions with physicians about potential risks of prostate cancer screening. Men received their health information through lay media, friends or family members. Educating men in the community through mass media about benefits and limitations of prostate cancer screening may be more effective to promote and facilitate shared decision making with their physicians.