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Factors Influencing Prostate Specific Antigen Testing in the United States
Nicolas von Landenberg1, Matthew Mossanen1, Ye Wang1
1Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Urology Practice
|June 14, 2023
Summary
Most men opt for prostate specific antigen screening, but older, Black, divorced, and men with other cancers are more likely to decline. Understanding these factors aids patient-centered prostate cancer screening discussions.
Area of Science:
- Urology
- Public Health
- Epidemiology
Background:
- Prostate specific antigen (PSA) screening for prostate cancer remains controversial regarding its overall benefit.
- Patient preferences are crucial when offering PSA screening.
- Identifying patient characteristics associated with screening decisions can improve care and counseling.
Purpose of the Study:
- To identify sociodemographic and clinical predictors of opting out of PSA testing.
- To understand patient preferences in prostate cancer screening.
Main Methods:
- Analysis of male participants aged 40+ from NHANES (2001-2010) without prior prostate cancer or related procedures.
- Standardized physician explanation of PSA screening provided to all participants.
- Logistic regression analysis adjusted for survey weights to determine predictors of declining PSA testing.
Main Results:
- 95.64% of eligible men underwent PSA testing.
- Higher odds of declining PSA testing were observed in men aged 80+, Black men, divorced/separated men, and those with non-prostate malignancies.
- Black men, despite higher prostate cancer risk, were more likely to refuse testing.
Conclusions:
- The majority of men offered PSA screening accepted it between 2001-2010.
- Specific demographic and clinical factors influence the decision to undergo PSA screening.
- Targeted counseling may be beneficial for subgroups less likely to opt for screening, particularly Black men.
