AUA 2017: Refusal of Prostate-specific Antigen Testing in The United States
They identified men from NHANES from 2001 – 2008 without a history of prostate cancer, recent prostate manipulation, or hormonal therapy use (n=6,032). Although the granular characteristics about the types of discussions, etc, that were had with each patient could not be analyzed, this data represents a “real-world” snapshot of the type of patient-physician interactions occurring around the discussion of PSA screening.
Interestingly, 95% of the identified population chose to undergo PSA screening after discussion with their physician, though given the time period studied, screening was far more indiscriminate. Men most likely to refuse screening were those older than 80yrs of age, black men (OR: 2.53; p<0.001), divorced/separated men, men with less than a high school education, and men with a pre-existing non-prostate malignancy.
Some of these findings are not surprising; indeed, older men should not be routinely screened in the first place and men with more competing risks (e.g. other malignancies) are poor candidates for routine screening. Unfortunately, the data clearly identifies black race as an independent predictor for refusal of screening.
This study adds to a growing body of evidence demonstrating that even though African American men have higher risks for aggressive prostate cancer, they are screened and treated less than white men. The history of medicine and African Americans in the United States is long, complicated, and often frankly unethical. Refusal by black men to undergo medical screening may be the result of this complex cultural memory. More must be done to improve outreach to this population.
Authors: Philipp Gild, Nicolas von Landenberg, Nawar Hanna, Ye Wang, Steven L Chang Boston, MA, Mani Menon, Detroit, MI
Felix K.H. Chun, Margit Fisch Hamburg, Germany, Quoc-Dien Trinh Boston, MA
Affiliation: Multi-institutional
Written By: Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA
Twitter: @ssjoshimd
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA