Patient and Physician Perceptions of Prostate-Specific Antigen Testing Among Black Individuals

Area of Science:

• Urology
• Public Health
• Health Disparities

Background:

• Black individuals experience a twofold higher mortality rate from prostate cancer in the US.
• Existing guidelines lack race-conscious recommendations for prostate cancer screening in high-risk populations.
• Structural factors influencing prostate cancer screening access for Black men require examination.

Purpose of the Study:

• To investigate structural factors that either facilitate or impede access to prostate cancer screening among Black individuals in the US.
• To understand the perspectives of Black men and healthcare providers regarding prostate-specific antigen (PSA) testing.

Main Methods:

• A qualitative, mixed-methods study conducted in clinical and community settings across six Northwestern states.
• Included semistructured interviews with 29 Black men at risk for prostate cancer.
• Surveyed 31 primary care practitioners (PCPs) and 32 urologists on their knowledge, attitudes, and practices regarding PSA testing.

Main Results:

• Interviewees perceived PCPs as gatekeepers to PSA testing, often lacking specific knowledge and holding unfavorable attitudes towards its use.
• Black men reported a lack of trusted relationships with PCPs for shared decision-making in screening.
• While aware of guidelines, PCPs were significantly less likely than urologists to value PSA testing for early detection and reducing mortality.

Conclusions:

• PCPs' perceptions and reliance on current guidelines, which exclude high-risk groups like Black men, create barriers to prostate cancer screening.
• Incorporating evidence-based guidance for PSA screening in Black individuals into existing guidelines could significantly improve early detection.
• Addressing provider knowledge, attitudes, and guideline limitations is crucial for reducing prostate cancer disparities.