Study Identifies Predictors of PSA Screening for Men in Florida

Predictors of prostate-specific antigen (PSA) screening among men in Florida include physician recommendation, discussions that included advantages, older age, non-smoking status, and having a personal doctor, new research suggests.

Individualized PSA screening may help reduce racial disparities in screening for prostate cancer (PCa) and help lower incidence and mortality rates, authors noted.

Findings were published in the International Journal of Environmental Research and Public Health.

A consensus around routine PCa screening with PSA continues to be debated, authors explained. Two large trials yielded mixed results with regard to the process’s association with reduced PCa- associated mortality. In addition, the studies revealed PSA-based screening could yield false positive results and potentially lead to a substantial overdiagnosis of PCa.

“Due to the absence of unanimous guidelines across medical organizations and agencies, a balanced discussion should take place between selected patients and providers about the advantages and disadvantages of the PSA test and the scientific uncertainty of its effectiveness in reducing mortality,” researchers said.

To better understand how the content and context of communication influence routine PSA testing in Florida, investigators assessed data from the Florida Behavioral Risk Factor Surveillance System (BRFSS).

Authors defined the content of communication as discussion of advantages and disadvantages of PSA testing between the provider and patient, anda provider’s recommendations of PSA testing. They defined communication context as continuity of care denoted by the presence of a personal doctor.

In addition, discussions were classified into four mutually exclusive categories: discussions of advantages and disadvantages, only advantages, only disadvantages, and no discussion.

Findings were adjusted for sociodemographic, clinical, health care access, and lifestyle characteristics.

A weighted total of 2,737,491 (n  = 5790) participants were included in the analysis. The majority of participants were white, around 24 % were Hispanic and around 12 % were Black. Around 35% of the study sample was between the ages 50 and 59.

Analyses revealed the most significant predictors for PSA testing included physician recommendation, discussions that included advantages, older age, non-smoking status, and having a personal doctor.

“Generally, physician recommendation has been shown to be strongly associated with the decision to have a PSA test. Our results showed that physician recommendation was the most significant predictor of screening, and these results agreed with those of another study,” researchers wrote.

Investigators also hypothesized race/ethnicity would be a significant predictor in the current study, as Black individuals are disproportionately affected by PCa.

Although shared decision making is recommended prior to PSA screening, studies have suggested Black men may not be making informed decisions about the screening due to low health literacy, knowledge about the test and past history of PSA screening.

“Healthcare providers may not be offering sufficient up-to-date information or may not be asking patients about their preferences, thereby hindering the shared decision-making process,” authors added. The latest findings show race was not a predictor for engaging in prostate cancer-related communication in Florida.

Because the dataset is limited to respondents living in Florida, findings may not be generalizable, marking a limitation. The dataset also represents a cross-sectional study and cannot determine causality. Both recall bias and non-response bias may have been present.

“Men who engaged in conversations with their physician, who were given recommendations for PSA testing by their providers, and who benefitted from the continuity of care denoted by the presence of a personal doctor had a greater likelihood of PSA receipt than those who did not experience these elements of patient-centered care,” authors concluded.

Reference

Alford NA, Wongpaiboon M, Luque JS, Harris CM, and Tawk RH. Associations of content and context of communication with prostate-specific antigen testing. Int J Environ Res Public Health. Published online May 4, 2023. doi:10.3390/ijerph20095721