Factors Influencing Prostate Specific Antigen Testing in the United States

Given the ongoing controversies regarding its benefit, prostate specific antigen based prostate cancer screening should be offered with patient preferences in mind. Understanding subsets of men who may or may not choose prostate specific antigen screening and their associated characteristics may allow more efficient care and may identify subsets of patients for whom additional counseling is warranted.

We analyzed male participants from the 2001 to 2010 cycles of the NHANES (National Health and Nutrition Examination Survey) who were 40 years old or older, and without a history of prostate cancer, recent prostate manipulation or hormone therapy use (8,133). All men were given an opportunity to undergo or refuse prostate specific antigen testing after a standardized explanation about prostate cancer screening from a physician. Univariable and multivariable logistic regressions were conducted after adjusting for survey weights to identify independent sociodemographic and clinical predictors for opting out of prostate specific antigen testing.

A total of 7,732 men met the inclusion criteria. Overall 95.64% of the study cohort elected to undergo prostate specific antigen testing. The odds of declining prostate specific antigen testing were significantly higher in men 80 years old or older (OR 1.78, p=0.008), black men (OR 3.23, p <0.001), divorced/separated men (OR 1.66, p=0.002) and men with a preexisting nonprostate malignancy (OR 1.65, p=0.012).

In the setting of the NHANES program, between 2001 and 2010 the majority of men who were offered prostate cancer screening underwent prostate specific antigen testing. Black men, a subgroup subject to more aggressive prostate cancer, were more likely to refuse prostate specific antigen testing.