Influence of life expectancy on shared decision-making for prostate cancer screening

The U.S. Preventive Services Task Force recommends that men aged 55-69 years undergo shared decision-making (SDM) regarding prostate cancer (PCa) screening, and routine screening is not recommended for older men or those with limited life expectancy. We evaluated the association between individual life expectancy and the receipt and content of SDM.

We identified male respondents aged ≥ 50 years and older without a history of PCa within the 2020 Behavioral Risk Factor Surveillance System survey. SDM was defined as whether a healthcare professional had ever discussed the advantages and/or disadvantages of a prostate-specific antigen test with the respondent. Life expectancy was estimated based on a validated index incorporating respondent age, comorbidities, and activities of daily living. Adjusted odds ratios (aOR) were estimated for the associations between respondent age, life expectancy, and receipt of SDM, accounting for healthcare access and utilization-related factors.

Reported receipt of any SDM was highest among 70-74-year-old men (62.6%, 95% CI 60.5-64.6%). In multivariable models, those with the lowest life expectancy were modestly less likely to receive SDM (aOR = 0.84, 95% CI 0.71-0.99, Q4 vs Q1) compared to those with the greatest life expectancy. SDM discussing only the advantages of screening was the most common form of SDM; the content of SDM conversations did not differ by age or life expectancy, and 14.5% of men who were recently screened reported no prior SDM whatsoever.

Life expectancy appears to be inadequately incorporated into decision-making regarding PCa screening. Additional tools are needed to support SDM conversations to improve the population benefits-harms of PCa screening.